Outcomes Among Patients With Reversible Cerebral Vasoconstriction Syndrome: A Nationwide United States Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Smit D. Patel ◽  
Karan Topiwala ◽  
Fadar Otite Oliver ◽  
Hamidreza Saber ◽  
Gregory Panza ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Nursing Home ◽  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Nationwide Inpatient Sample ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Inpatient Mortality ◽  
Seizure Disorders ◽  
Cerebral Vasoconstriction

Background and Purpose: Reversible cerebral vasoconstriction syndrome (RCVS) is a well-established cause of stroke, but its demographics and outcomes have not been well delineated. Methods: Analysis of the United States Nationwide Inpatient Sample database (2016–2017) to characterize the frequency of hospitalizations for RCVS, demographic features, inpatient mortality, and discharge outcomes. Results: During the 2-year study period, 2020 patients with RCVS were admitted to Nationwide Inpatient Sample hospitals, representing 0.02 cases per 100 000 national hospitalizations. The mean age at admission was 47.6 years, with 85% under 65 years of age, and 75.5% women. Concomitant neurological diagnoses during hospitalization included ischemic stroke (17.1%), intracerebral hemorrhage (11.0%), subarachnoid hemorrhage (32.7%), seizure disorders (6.7%), and reversible brain edema (13.6%). Overall, 70% of patients were discharged home, 29.7% discharged to a rehabilitation facility or nursing home and 0.3% died before discharge. Patient features independently associated with the poor outcome of discharge to another facility or death were advanced age (odds ratio [OR], 1.04 [95% CI, 1.03–1.04]), being a woman (OR, 2.45 [1.82–3.34]), intracerebral hemorrhage (OR, 2.91 [1.96–4.31]), ischemic stroke (OR, 5.72 [4.32–7.58]), seizure disorders (OR, 2.61 [1.70–4.00]), reversible brain edema (OR, 6.26 [4.41–8.89]), atrial fibrillation (OR, 2.97 [1.83–4.81]), and chronic kidney disease (OR, 3.43 [2.19–5.36]). Conclusions: Projected to the entire US population, >1000 patients with RCVS are hospitalized each year, with the majority being middle-aged women, and about 300 required at least some rehabilitation or nursing home care after discharge. RCVS-related inpatient mortality is rare.

Abstract P686: Ischemic Stroke in Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aayushi Garg ◽  
Amjad Elmashala ◽  
Santiago Ortega
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Survey Design ◽  
Inpatient Rehabilitation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Hospital Charges ◽  
Multivariable Logistic Regression Analysis ◽  
Cerebral Vasoconstriction ◽  
History Of

Introduction: Ischemic stroke is the cause for major morbidity and mortality in reversible cerebral vasoconstriction syndrome (RCVS). While there is evidence to suggest that ischemic stroke in RCVS is associated with proximal vasoconstriction, it is still unclear why some patients develop ischemic lesions. The aim of this study was to evaluate the risk factors and outcomes of ischemic stroke in RCVS. Methods: We utilized the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations with the discharge diagnosis of RCVS. Occurrence of acute ischemic stroke was identified. Hospitalizations with the diagnosis of hemorrhagic stroke were excluded. Survey design methods were used to generate national estimates. Independent predictors of ischemic stroke were analyzed using multivariable logistic regression analysis with results expressed as odds ratio (OR) and 95% confidence intervals (CI). Results: Among the total 1,065 hospitalizations for RCVS during the study period (mean±SD age: 49.0±16.7 years, female 69.7%), 267 (25.1%) had occurrence of acute ischemic stroke. Patients with ischemic stroke were more likely to have history of hypertension (OR 2.33, 95% CI 1.51-3.60), diabetes (OR 1.81, 95% CI 1.11-2.98), and tobacco use (OR 1.64, 95% CI 1.16-2.33) and less likely to have a history of migraine (OR 0.56, 95% CI 0.35-0.90). Patients with stroke were more likely to develop cerebral edema. They also had longer hospital stay, higher hospital charges, and lower likelihood of being discharged to home or inpatient rehabilitation facility. They had higher in-hospital mortality rate, the difference was however not statistically significant. Conclusion: In conclusion, ischemic stroke affects nearly 25% of patients with RCVS and is associated with an increased rate of other neurologic complications and worse functional outcomes. Patients with traditional cerebrovascular risk factors might have a higher predisposition for developing the ischemic lesions.

scholarly journals Intracerebral Hemorrhage and Reversible Cerebral Vasoconstriction Syndrome in a Patient With COVID-19

Cureus ◽  
2021 ◽  
Author(s):  
Aswin Srinivasan ◽  
Branden C Wilson ◽  
Matthew Bear ◽  
Ammar Hasan ◽  
Obadah Ezzeldin ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction

Abstract 58: Rates of In-Hospital Adverse Events and Discharge Outcomes Among Ischemic Stroke Patients Admitted to Joint Commission Primary Stroke Centers in United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Taqi T Zafar ◽  
Muhammad Umair ◽  
Gautam Sachdeva ◽  
Mohammad Afzal ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Adverse Events ◽  
Nationwide Inpatient Sample ◽  
Joint Commission ◽  
Principal Diagnosis ◽  
Stroke Patients ◽  
Discharge Outcomes ◽  
Beneficial Impact ◽  
To Receive

Background: The beneficial impact of certification by Joint Commission (JC) for primary stroke centers (PSCs), on in hospital adverse events and outcomes remains unproven. Objective: To compare the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients between PSC and no PSC hospitals in United States. Methods and Results: We obtained the data from Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the NIS hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (ICD9 codes 433.x1, 434.x1, 436). Results: We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted at PSCs. Patients admitted at PSCs were more likely to be men (48.3 vs. 46.7, p<0.0001), white (75.2 vs. 73.3, p<0.0001) and younger in age (71.1±14.7 vs. 72.3±14.3 p<0.0001. Total length of stay was similar among PSCs and non-PSCs (5.09±6. vs. 5.14±6.15 p<0.0001), while total charges were higher at PSCs ($48828 vs. $35946±14.3 p<0.0001). After adjusting for age, sex, race co-morbidities, DRG-based disease severity, and hospital characteristics, patients admitted at PSCs were at lower risk of in hospital adverse events complications; pneumonia (OR, 0.8; 95% CI, 0.7 to 0.9)-, urinary tract infection (OR, 0.97; 95% CI, 0.0.92 to 1.02), sepsis (OR, 0.65; 95% CI, 0..56 to 0..76), deep venous thrombosis (OR, 1.0; 95% CI, 0.76 to 1.33) and pulmonary embolism (OR, 0.58; 95% CI, 0.43 to 0.72). Patients evaluated at PSCs were more likely to receive rt-PA (OR, 1.32; 95% CI, 1.19 to 1.45) with less impatient mortality (OR, 0.88; 95% CI, 0.81 to 0.96) and more likely to get discharge to home (OR, 1.11; 95% CI, 1.07 to 1.15). Conclusions: Patients admitted to PSCs are less likely to have in hospital adverse events and better discharge outcomes.

Abstract WP354: Ten-year Temporal Trends in Medical Complications Following Acute Intracerebral Hemorrhage in the United States

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Amer M Malik ◽  
Seemant Chaturvedi ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
United States ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Temporal Trends ◽  
The United States ◽  
Medical Complications ◽  
Innovative Strategies ◽  
The Us ◽  
Acute Intracerebral Hemorrhage ◽  
Over Time

Background: Data on medical complications following intracerebral hemorrhage (ICH) are sparse. We assessed trends in the prevalence of urinary tract infection (UTI), pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism (PE), acute renal failure (ARF) and acute myocardial infarction (AMI) following ICH in the United States and evaluated their association with in-hospital mortality (IM), cost, length-of-stay (LOS) and home disposition (HD). Methods: Adults admitted to US hospitals from 2004-2013 (n=582,736) were identified from the Nationwide Inpatient Sample. Weighted complication risks were computed by sex and by mechanical ventilation (MV) status. Multivariate models were used to evaluate trends in complication and to assess their association with IM, cost, LOS, and HD. Results: Overall risks of UTI, pneumonia, sepsis, DVT, PE, ARF and AMI following ICH were 14.8%, 7.7%, 4.1%, 2.7%, 0.7%, 8.2% and 2.0% respectively. Risks differed by sex (UTI: females (F) 19.8% vs males (M) 9.9%; ARF: M 10.6% vs F 5.9%; sepsis: M 4.8% vs F 3.4%) and by MV status (pneumonia: MV 17.7% vs non-MV 3.9%; DVT: MV 4.3% vs non-MV 3.2%). From 2004 to 2103, odds of DVT and ARF increased while odds of pneumonia, sepsis and mortality declined over time (figure 1). Each complication was associated with > 2.5-day increase in mean LOS, > $8,000 increase in cost and reduced odds of HD. ARF and AMI were associated with increased IM in all patients; sepsis and pneumonia were associated with increased IM only in non-MV patients while UTI and DVT were associated with reduced IM in all patients. Conclusion and Relevance: Despite IM reduction, ARF and DVT risk following ICH in the US have increased while odds of sepsis and pneumonia have declined over time. All complications were associated with increased cost, LOS and reduced odds of HD but their associations with IM were variable, likely due in part to survival bias. Innovative strategies are needed to prevent ICH-associated medical complications.

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