Abstract P384: Outcomes of Endovascular Therapy in Patients With Pre-Stroke Mobility Impairment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rachel Beekman ◽  
Jie-Lena Sun ◽  
Brooke Alhanti ◽  
Lee H Schwamm ◽  
Eric Smith ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Stroke Severity ◽  
Limited Data ◽  
Mobility Impairment ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Get With The Guidelines

Background and Purpose: Patients with pre-stroke mobility impairment were excluded from endovascular clinical trials. There is limited data regarding safety and outcomes of endovascular thrombectomy (EVT) in this population. We used a large, national dataset (Get With The Guidelines (GWTG)-Stroke) to evaluate the safety and outcomes of EVT in patients with pre-stroke mobility impairment (PSMI). Methods: We included patients who underwent EVT in the GWTG-Stroke registry between 2015 and 2019. PSMI was defined as inability to ambulate independently and poor outcome was defined as in-hospital mortality or discharge to hospice. GEE logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56,762 patients treated with EVT, 2919 (5.14%) had PSMI. Patients with PSMI were older (median 79 [IQR 70-87] vs 70 [59-80], P<0.001), more likely to be female (63.4% vs 49.2%, P<0.001), had more medical comorbidities, presented with a higher NIHSS (19 [12-24] vs 15 [9-21], P<0.001), and were less likely to be treated with tPA (36.8% vs 45.6%, P<0.001). PSMI was not associated with intracranial hemorrhage but was associated with poor outcome (Table 1). Patients with PSMI with poor outcomes were more likely to be older (83 [74-89] vs 77 [68-86], P<0.001) and have a higher presenting NIHSS (21 [16-25] vs 16 [11-22], p<0.001). Forty-nine percent of patients with PSMI with age >80 years and NIHSS >20 had a poor outcome. Conclusions: Amongst patients with PSMI treated with EVT, two thirds survived and one third were discharged to home or to inpatient rehabilitation. Advanced age and increased stroke severity increased the likelihood of poor outcomes. EVT appears safe in patients with PSMI, yet further study of effectiveness in this population is warranted.

scholarly journals Outcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment

Stroke ◽  
2021 ◽  
Author(s):  
Rachel Beekman ◽  
Jie-Lena Sun ◽  
Brooke Alhanti ◽  
Lee H. Schwamm ◽  
Eric E. Smith ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Hospital Death ◽  
Limited Data ◽  
Mobility Impairment ◽  
Data Set ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Symptomatic Intracranial Hemorrhage ◽  
Get With The Guidelines

Background and Purpose: Patients with prestroke mobility impairment (PSMI) were excluded from endovascular clinical trials. There are limited data regarding safety and outcomes of endovascular thrombectomy in this population. We used a large, national data set (Get With The Guidelines–Stroke) to evaluate the safety and outcomes of endovascular thrombectomy in patients with PSMI. Methods: We included patients who underwent endovascular thrombectomy in the Get With The Guidelines–Stroke registry between 2015 and 2019. PSMI was defined as the inability to ambulate independently. Generalized estimating equations for logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56 762 patients treated with endovascular thrombectomy, 2919 (5.14%) had PSMI. PSMI was not associated with symptomatic intracranial hemorrhage (6.0% versus 5.4%; P =0.979). In-hospital death or discharge to hospice occurred in 32.3% of patients with PSMI versus 17.5% without PSMI (adjusted odds ratio, 1.45 [1.32–1.58]). Conclusions: While procedural adverse outcomes were no higher in patients with PSMI, further study is necessary to determine clinical benefit in this population.

Dysphagia screening after intracerebral hemorrhage

2017 ◽  
Vol 13 (5) ◽  
pp. 503-510 ◽  
Author(s):  
Raed A Joundi ◽  
Rosemary Martino ◽  
Gustavo Saposnik ◽  
Vasily Giannakeas ◽  
Jiming Fang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Clinical Severity ◽  
Stroke Severity ◽  
Stroke Registry ◽  
Patients At Risk ◽  
Poor Outcomes ◽  
Risk Of Aspiration ◽  
To Receive

Background Dysphagia screening is recommended after acute stroke to identify patients at risk of aspiration and implement appropriate care. However, little is known about the frequency and outcomes of patients undergoing dysphagia screening after intracerebral hemorrhage (ICH). Methods We used the Ontario Stroke Registry from 1 April 2010 to 31 March 2013 to identify patients hospitalized with acute stroke and to compare dysphagia screening rates in those with ICH and ischemic stroke. In patients with ICH we assessed predictors of receiving dysphagia screening, predictors of failing screening, and outcomes after failing screening. Results Among 1091 eligible patients with ICH, 354 (32.4%) patients did not have documented dysphagia screening. Patients with mild ICH were less likely to receive screening (40.4% of patients were omitted, adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI) 0.26–0.63). Older age, greater stroke severity, speech deficits, lower initial level of consciousness, and admission to intensive care unit were predictive of failing the screening test. Failing screening was associated with poor outcomes, including pneumonia (aOR 5.3, 95% CI 2.36–11.88), severe disability (aOR 4.78, 95% CI 3.08–7.41), and 1-year mortality (adjusted hazard ratio 2.1, 95% CI 1.38–3.17). When compared to patients with ischemic stroke, patients with ICH were less likely to receive dysphagia screening (aOR 0.64, 95% CI 0.54–0.76) and more likely to fail screening (aOR 1.98, 95% 1.62–2.42). Conclusion One-third of patients with ICH did not have documented dysphagia screening, increasing to 40% in patients with mild clinical severity. Failing screening was associated with poor outcomes. Patients with ICH were less like to receive screening and twice as likely to fail compared to patients with ischemic stroke, and thus efforts should be made to include ICH patients in dysphagia screening protocols whenever possible.

Gender Differences in Characteristics and Outcome in Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (4) ◽  
pp. 321-327
Author(s):  
Rui Guo ◽  
Lu Yin ◽  
Ruiqi Chen ◽  
Liang Zhou ◽  
Chao You ◽  
...  
Keyword(s):  
Gender Differences ◽  
Intraventricular Hemorrhage ◽  
Chronic Alcoholism ◽  
Monocyte Count ◽  
Rare Type ◽  
Acute Hydrocephalus ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Gcs Score

Background: Primary intraventricular hemorrhage (PIVH) is a rare type of Intracerebral Hemorrhage (ICH), which is poorly understood. This study aimed to investigate gender differences in patients' characteristics, management and outcome at discharge and 90 days after PIVH. Methods: Consecutive patients with PIVH from a single center in China were enrolled over a 7- year period. Gender differences in demographics, risk factors, etiological subtypes, treatment, and outcomes were examined. The logistic regression models were used in the study to identify the predictors of poor outcome. Results: In total, 174 patients were analyzed, and 77 (44.3%) of them were women. Women with PIVH were younger (p = 0.047), with lower systolic and diastolic blood pressure (p = 0.02 and p = 0.004, respectively). They had more cases caused by Moyamoya disease (p = 0.038). There were fewer patients with hypertension (p = 0.008), smoking (p＜0.001), chronic alcoholism (p＜0.001), harbored lower hemoglobin (p＜0.001) and Absolute Monocyte Count (AMC) (p = 0.04) at admission compared with men. There were no differences between female and male patients regarding the mortality and poor outcome in the multivariable-adjusted models ((OR = 0.57; 95% CI, 0.15-2.14) and (OR = 0.86; 95% CI, 0.32-2.37), respectively). In subgroup analysis after adjustment, the gender specific independent predictors for unfavorable outcome were higher with a Graeb score (OR = 1.78; 95% CI, 1.01-3.13) or AMC (OR = 9.66; 95% CI, 1.20-12.87) in women, and lower Glasgow coma scale (GCS) score (OR = 0.64; 95% CI, 0.47-0.87) or acute hydrocephalus (OR = 0.17; 95% CI, 0.03-0.86) in men. Conclusions: Women with PIVH exhibit some distinctive baseline features compared with men. The gender difference of the PIVH does not appear to affect the neurological outcome. The predictors of poor outcomes are Graeb score and AMC in women and GCS score and acute hydrocephalus in men.

Microbleeds, Cerebral Hemorrhage, and Functional Outcome after Endovascular Thrombectomy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011566
Author(s):  
Imad DERRAZ ◽  
Federico CAGNAZZO ◽  
Nicolas GAILLARD ◽  
Riccardo MORGANTI ◽  
Cyril DARGAZANLI ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Stroke Severity ◽  
Confounding Factors ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Poor Outcome ◽  
Increased Risk

Objective—To determine whether pre-treatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).Methods—Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin score >2).Results—Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH, in which 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03–1.36 per 1-CMB increase; P=0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, intravenous thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92–1.20 per 1-CMB increase; P=0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, nor presumed pathogenesis was independently correlated with ICH.Conclusions—Poor functional outcome or ICH were not correlated with CMB presence or burden on pre–EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted.Classification of Evidence—This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.

Abstract P35: Mild or Improving Stroke is the Most Frequently Documented Reason for Not Giving rt-PA in Time-Eligible Acute Ischemic Stroke Patients: Findings From Get With the Guidelines-Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Eric E Smith ◽  
Gregg C Fonarow ◽  
Mathew J Reeves ◽  
Margueritte Cox ◽  
DaiWai Olson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
National Study ◽  
Stroke Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Poor Outcomes ◽  
Get With The Guidelines

Introduction: Previous studies suggest that mild or improving stroke is a frequently cited reason for not giving IV rt-PA and that some of these patients have poor outcomes. Methods: We examined the frequency of rt-PA use and contraindications among acute ischemic stroke patients arriving ≤2 hrs in the Get With The Guidelines-Stroke Program. Results: Between 4/1/2003-9/29/2009 there were 98,708 patients who arrived directly to the hospital within 2 hours. Among these patients 26.4% received IV rt-PA, 30.9% did not receive rt-PA solely because of mild/improving stroke, 28.6% had other contraindications, and 14.1% had no documented contraindications. From 2003-2009 rtPA use increased, the proportions not given rtPA despite no documented contraindications decreased, and the proportions with mild/improving stroke or other contraindications were similar (Figure). The initial NIH Stroke Scale (NIHSS) was recorded in 62.1% with mild/improving stroke and 82.3% given rt-PA; 75% of mild/improving stroke patients had NIHSS <5 while 90% of IV rt-PA-treated patients had NIHSS ≥5. Short-term outcomes in patients with mild/improving stroke were not always good: 1.1% died, 0.7% were discharged to hospice, 10.3% to a skilled nursing facility and 15.1% to an inpatient rehabilitation facility. Conclusion: In this large national study, mild/improving stroke is the most common reason for not giving rt-PA to early arriving patients. More patients are excluded because of mild/improving stroke than are treated with rt-PA. When deciding whether to withhold thrombolysis in patients with mild/improving stroke, clinicians should consider the risk of poor outcomes in this population.

Abstract P52: Absence of Dysphagia is a Stronger Predictor of Favorable Discharge Disposition than Stroke Severity: Insights from the UTHSC Houston Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Nneka I Jones ◽  
Nusrat Harun ◽  
Elizabeth Noser ◽  
James Grotta
Keyword(s):  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Stroke Care ◽  
Level Of Care ◽  
Stroke Severity ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Stroke Registry ◽  
Post Stroke ◽  
Discharge Disposition

Introduction: Dysphagia is one of the most common post-stroke complications. The use of feeding tubes to provide nutrition requires increased acuity of care for management, which affects costs. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute (Sub). There are limited studies of the role of dysphagia as a predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher function. We assessed the hypothesis that the absence of tube feeds as an indicator of dysphagia is a predictor of post-stroke disposition to a similar functional level. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age >65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed to determine if differences in post-stroke disposition were present among patients not receiving tube feeds as an indicator of dysphagia. Results: Home vs. Other Level of Care Of 3389 patients, 1668 were discharged home, 1721 to another level of care. Patients without tube feeds are 14.6 times more likely to be discharged home (P = <.0001, OR 14.66, 95% CI 8.05 to 26.69) Patients with NIHSS < 8 are 10.9 times more likely to be discharged home. IR vs. SNF Of 1546 patients, 983 were discharged to acute IR, 563 to SNF. Patients without tube feeds are 6.1 times more likely to be discharged to IR (P = <.0001, OR 6.118, 95% CI 4.34 to 8.63). Patients with NIHSS < 8 are 2.5 times more likely to be discharged to IR. SNF vs. Sub Of 738 patients, 563 were discharged to SNF, 175 to Sub. Patients without tube feeds are 3 times more likely to be discharged to SNF (P = <.0001, OR 2.999, 95% CI 2.048 to 4.390). Patients with NIHSS < 8 are 2 times more likely to be discharged to SNF. Conclusions: The absence of tube feeds as an indicator of dysphagia is a predictor of improved post-stroke disposition, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies should focus on early diagnosis, therapeutic intervention and caregiver involvement in dysphagia education to improve outcomes and decrease the cost of post-stroke care.

Abstract 96: What Critical Volume of Intraventricular Hemorrhage is Important in Intracerebral Haemorrhage? Interact2 Results

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Craig Anderson ◽  
Edward Chan ◽  
Xia Wang ◽  
Hisatomi Arima ◽  
Emma Heeley ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Linear Relation ◽  
Controlled Trial ◽  
Intraventricular Haemorrhage ◽  
Clinical Severity ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Threshold Volume ◽  
Clinically Significant ◽  
Poor Outcomes

Background and purpose: Intraventricular haemorrhage (IVH) predicts outcome in acute intracerebral haemorrhage (ICH), but there is uncertainty over the strength of association and what clinically relevant threshold volume is relevant to prognosis. We aimed to elucidate risk associations of IVH and outcome in participants of the INTERACT2 study. Methods: INTERACT2 was an international, multicenter, prospective, open, blinded endpoint, randomized controlled trial of 2839 patients with ICH (<6 hr) and elevated systolic BP (SBP) who were randomly assigned to intensive (target SBP <140mmHg) or guideline-based (SBP <180mmHg) BP management in 2008-2012. Associations of 740 (26%) patients with IVH on poor outcome (mRS >3) at 90 days, were determined in logistic regression models. Results: Patients with ICH-IVH were significantly older, had greater clinical severity, and more with prior ischemic stroke and deep and large hematoma volume, after adjustment for other variables. Poor outcome occurred in 67% of ICH-IVH patients compared with 49% of ICH-alone patients (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.42-0.60; p<0.01). There was a strong linear relation between ICH volume and poor outcome. Compared to lowest quartile (Q1) IVH volume (0-2.07mL), OR for poor outcomes increased in Q2 (2.08-5.84 mL) 0.74 (95%CI 0.46-1.18 mL), Q3 (5.97-13-74 ml) 1.27 (95%CI 0.78-2.06), and Q4 (13.82-117.55) 1.56 (95%CI 0.94-2.58), p trend 0.03. Associations were stronger for death, where a baseline IVH volume of 5-10mL emerging as a statistically (and clinically) significant threshold for risk. Conclusion: While a linear relation exists between IVH and outcome in ICH, a 5-10mL volume appears an appropriate cut-point for clinical-decisions over use of interventions with risk.

scholarly journals In-Hospital Cardiac Arrest Resuscitation Practices and Outcomes in Maintenance Dialysis Patients

2020 ◽  
Vol 15 (2) ◽  
pp. 219-227 ◽  
Author(s):  
Monique Anderson Starks ◽  
Jingjing Wu ◽  
Eric D. Peterson ◽  
Judith A. Stafford ◽  
Roland A. Matsouaka ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Dialysis Patients ◽  
Logistic Regression Models ◽  
Initial Rhythm ◽  
Maintenance Dialysis ◽  
Poor Outcomes ◽  
Composite Scores ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background and objectivesPatients on maintenance dialysis with in-hospital cardiac arrest have been reported to have worse outcomes relative to those not on dialysis; however, it is unknown if poor outcomes are related to the quality of resuscitation. Using the Get With The Guidelines-Resuscitation (GWTG-R) registry, we examined processes of care and outcomes of in-hospital cardiac arrest for patients on maintenance dialysis compared with nondialysis patients.Design, setting, participants, & measurementsWe used GWTG-R data linked to Centers for Medicare and Medicaid data to identify patients with ESKD receiving maintenance dialysis from 2000 to 2012. We then case-matched adult patients on maintenance dialysis to nondialysis patients in a 1:3 ratio on the basis of age, sex, race, hospital, and year of arrest. Logistic regression models with generalized estimating equations were used to assess the association of in-hospital cardiac arrest and outcomes by dialysis status.ResultsAfter matching, there were a total of 31,144 GWTG-R patients from 372 sites, of which 8498 (27%) were on maintenance dialysis. Patients on maintenance dialysis were less likely to have a shockable initial rhythm (20% versus 21%) and less likely to be within the intensive care unit at the time of arrest (46% versus 47%) compared with nondialysis patients; they also had lower composite scores for resuscitation quality (89% versus 90%) and were less likely to have defibrillation within 2 minutes (54% versus 58%). After adjustment, patients on maintenance dialysis had similar adjusted odds of survival to discharge (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 0.97 to 1.13), better acute survival (OR, 1.33; 95% CI, 1.26 to 1.40), and were more likely to have favorable neurologic status (OR, 1.12; 95% CI, 1.04 to 1.22) compared with nondialysis patients.ConclusionsAlthough there appears to be opportunities to improve the quality of in-hospital cardiac arrest care for among those on maintenance dialysis, survival to discharge was similar for these patients compared with nondialysis patients.

scholarly journals P.066 Failing a dysphagia screen after acute ischemic stroke is highly predictive of poor outcomes

2016 ◽  
Vol 43 (S2) ◽  
pp. S36-S36
Author(s):  
RA Joundi ◽  
R Martino ◽  
G Saposnik ◽  
J Fang ◽  
V Giannakeas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Decubitus Ulcer ◽  
Stroke Severity ◽  
Term Care ◽  
Stroke Registry ◽  
Feeding Tubes ◽  
Multivariable Regression ◽  
Baseline Factors ◽  
Poor Outcomes

Background: Bedside dysphagia screening is recommended for all patients with acute ischemic stroke, in order to detect swallowing impairment early and prevent complications. However, limited data are available on outcomes associated with failing a dysphagia screen. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional Stroke Centres from 2010-2013 and received a dysphagia screen within 72 hours. We used multivariable regression to determine outcomes of patients who failed the dysphagia screen. Results: Among 5145 patients who underwent dysphagia screening, 2458 (47.8%) failed and 2687 (52.2%) passed. Patients who failed had more co-morbidities and presented with more severe strokes (mean NIHSS 11.0 vs. 5.4). Among those who failed, 9% required permanent feeding tubes, versus 0.1% among those who passed. After controlling for age, co-morbidities, and stroke severity, failing a bedside swallowing screen remained highly predictive of poor outcomes, including decubitus ulcer (adjusted odds ratio aOR 10.5), pneumonia (aOR 4.6), discharge to long-term care (aOR 4.1) and 30-day mortality (aOR 4.5; 16.6% vs. 2.2%). *All p <0.0001 Conclusions: Patients who failed a dysphagia screen on admission had dramatically worse outcomes after controlling for baseline factors. A bedside dysphagia screen provides immediate risk stratification for acute stroke patients and can be used to guide appropriate care.

Abstract TP335: Hospital-Acquired Infection is Associated with Poor Outcome in Young Adults with Hemorrhagic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kathryn M Sundheim ◽  
Eliza C Miller ◽  
Joshua Z Willey ◽  
Randolph S Marshall ◽  
Yuefan Shao ◽  
...  
Keyword(s):  
Young Adults ◽  
Hemorrhagic Stroke ◽  
Patient Characteristics ◽  
Single Center ◽  
Hospital Acquired Infection ◽  
Stroke Registry ◽  
Poor Outcome ◽  
Single Center Study ◽  
Poor Outcomes ◽  
Hospital Acquired

Background and Purpose: Infections are associated with poor outcomes in young people with ischemic stroke, particularly if they are hospital-acquired. However, the influence of infection on hemorrhagic stroke outcomes in a young population is less well characterized. Methods: We conducted a single-center retrospective analysis of a prospectively collected stroke registry, for patients, aged 18-45, admitted with hemorrhagic stroke of any type from 01/2008 to 03/2015. We reviewed charts for study variables, including patient characteristics, risk factors, and hospital-acquired infections (HAI) or infections present on admission (POA). Poor outcome was defined as modified Rankin score of 3-6 at time of discharge. We compared patients with HAI and infection POA to those without an infection. Results: Of the 219 hemorrhage cases in young adults, 31 (14%) had an infection POA, and 65 (29.7%) had a HAI. As shown in the table, patients who had a HAI and a POA infection had higher baseline NIHSS than those without an infection. In the unadjusted analyses, POA infections (OR = 2. 96, 95%CI: 1.91-4.58) and HAI (OR= 6.51, 95%CI: 4.06 - 10.44) are associated with poor mRS on discharge for hemorrhagic stroke. Adjusting for NIHSS, the relationship between POA infections and poor outcome is no longer significant (OR = 1.45, 95%CI: 0.34- 6.27) while HAI remains associated with poor outcome (OR= 6.73, 95%CI: 2.22 - 20.41). In SAH only patients, after adjusting for NIHSS, HAI remains associated with poor outcome (OR = 21.61, 95%CI: 3.35 - 139) while POA infections are not associated (OR = 3.01, 95%CI: 0.294 - 30.8). In ICH only patients, after adjusting for NIHSS, neither HAI (OR = 3.18, 95%CI: 0.656 - 15.4) nor POA infections (OR = 2.19, 95%CI: 0.334- 14.3) are associated with poor outcomes. Conclusions: In our single-center study, HAI, but not infections POA, were associated with poor outcomes in young adults with SAH. This relationship was not seen in patients with ICH.

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