scholarly journals Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 155-166 ◽  
Author(s):  
David E. Newman-Toker ◽  
Ernest Moy ◽  
Ernest Valente ◽  
Rosanna Coffey ◽  
Anika L. Hines
Keyword(s):  
Emergency Department ◽  
Large Population ◽  
Population Based ◽  
Teaching Hospitals ◽  
Older Individuals ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Cerebrovascular Events ◽  
Asian Pacific ◽  
Sectional Analysis

AbstractSome cerebrovascular events are not diagnosed promptly, potentially resulting in death or disability from missed treatments. We sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics.Cross-sectional analysis using linked inpatient discharge and ED visit records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases and 2008–2009 State ED Databases across nine US states. We identified adult patients admitted for stroke with a treat-and-release ED visit in the prior 30 days, considering those given a non-cerebrovascular diagnosis as probable (benign headache or dizziness diagnosis) or potential (any other diagnosis) missed strokes.There were 23,809 potential and 2243 probable missed strokes representing 12.7% and 1.2% of stroke admissions, respectively. Missed hemorrhages (n=406) were linked to headache while missed ischemic strokes (n=1435) and transient ischemic attacks (n=402) were linked to headache or dizziness. Odds of a probable misdiagnosis were lower among men (OR 0.75), older individuals (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥75:OR 0.19), and Medicare (OR 0.66) or Medicaid (OR 0.70) recipients compared to privately insured patients. Odds were higher among Blacks (OR 1.18), Asian/Pacific Islanders (OR 1.29), and Hispanics (OR 1.30). Odds were higher in non-teaching hospitals (OR 1.45) and low-volume hospitals (OR 1.57).We estimate 15,000–165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. Physicians evaluating these symptoms should be particularly attuned to the possibility of stroke in younger, female, and non-White patients.

scholarly journals The association between serum alanine aminotransferase and hypertension: A national based cross-sectional analysis among over 21 million Chinese adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiajing Jia ◽  
Ying Yang ◽  
Fangchao Liu ◽  
Minjin Zhang ◽  
Qin Xu ◽  
...  
Keyword(s):  
Alanine Aminotransferase ◽  
Elevated Serum ◽  
Population Based ◽  
Reproductive Age ◽  
Chinese Adults ◽  
Cross Sectional ◽  
Serum Alanine Aminotransferase ◽  
Cross Sectional Analysis ◽  
Registration Data ◽  
Sectional Analysis

Abstract Background Inconsistent results were found in the association between serum alanine aminotransferase (ALT) and hypertension among population-based studies. This study evaluated the association between ALT and hypertension among Chinese reproductive-age population by utilizing registration data from National Free Pre-pregnancy Checkups Project in 2016–2017. Methods The 21,103,790 registered participants were eligible for analysis, including women who were 20–49 years old and men who were 20–59 years old with available data for ALT and blood pressure (BP). Logistic regression was conducted to estimate odds ratio (OR) for the association between ALT and hypertension as a binary outcome. Linear regression was used to examine the association between ALT and BP as a continuous outcome. Results In total, 4.21% of the participants were hypertensive, and 11.67% had elevated ALT (> 40 U/L). Hypertension prevalence was 3.63% and 8.56% among participants with normal and elevated ALT levels. A strong linear relationship was found between serum ALT levels and the odds of hypertension after adjustment for potential confounders. The multivariable-adjusted ORs for hypertension were 1, 1.22 (1.21, 1.22), 1.67 (1.65 1.68), 1.78 (1.76, 1.80), and 1.92 (1.90, 1.94) in participants with ALT levels of ≤ 20, 20.01–40, 40.01–60, 60.01–80, and > 80 U/L, respectively. Systolic and diastolic BPs rose by 1.83 and 1.20 mmHg on average, for each 20 U/L increase in ALT (P for trend < 0.001). The association was consistent among subgroups and tended to be stronger among populations who are overweight (body mass index ≥ 24 kg/m2) (χ2 = 52,228, P < 0.001), alcohol drinking (χ2 = 100,730, P < 0.001) and cigarette smoking (χ2 = 105,347, P < 0.001). Conclusions Our cross-sectional analysis suggested a linear association between serum ALT and hypertension or BP, which indicated that abnormal liver metabolism marked by elevated serum ALT could play a role in hypertension or elevated BP condition.

Non-pharmacological management of adult asthma in Australia: cross-sectional analysis of a population-based cohort study

2018 ◽  
Vol 57 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Daniel J. Tan ◽  
John A. Burgess ◽  
Jennifer L. Perret ◽  
Dinh S. Bui ◽  
Michael J. Abramson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Cross Sectional ◽  
Pharmacological Management ◽  
Adult Asthma ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

scholarly journals Comorbidities in adults with asthma: Population-based cross-sectional analysis of 1.4 million adults in Scotland

2017 ◽  
Vol 47 (10) ◽  
pp. 1246-1252 ◽  
Author(s):  
C. J. Weatherburn ◽  
B. Guthrie ◽  
S. W. Mercer ◽  
D. R. Morales
Keyword(s):  
Population Based ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

Abstract P214: Anxiety and Depressive Symptoms are Associated with Coronary Artery Calcium. A Cross-sectional Analysis of Elsa-Brasil Baseline Data

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Itamar S Santos ◽  
Marcio S Bittencourt ◽  
Priscila T Rocco ◽  
Alexandre C Pereira ◽  
Sandhi M Barreto ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Adult Health ◽  
Older Individuals ◽  
Cross Sectional ◽  
Psychopathological Symptoms ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
Age And Sex

Background: Prior mostly smaller studies of the association between symptoms of anxiety or depression and CAC have produced mixed results. Our aim was to investigate whether psychopathological symptoms and diagnoses of anxiety and depression were associated with coronary artery calcium (CAC) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Design: Cross-sectional analysis Methods: We analyzed data from 4,279 ELSA-Brasil subjects (aged 35 to 74 years) from the São Paulo site who underwent CAC score assessment and who were without previous cardiovascular disease at baseline. Prevalent CAC was defined as a CAC score above zero. Anxiety and depressive symptoms were assessed using the Clinical Interview Schedule - Revised (CIS-R). We built binary logistic regression models to determine whether CIS-R scores, anxiety or depression were associated with prevalent CAC. Results: Prevalent CAC was found in 1,211 (28.3%) individuals. After adjustment for age and sex, a direct association between CIS-R scores and prevalent CAC was revealed (odds ratio [OR]:1.12; 95% confidence interval [95%CI]:1.04-1.22). This association persisted after multivariate adjustment for other cardiovascular risk factors (OR:1.11; 95%CI: 1.02-1.20). No independent associations were found for specific diagnoses of anxiety or depression and prevalent CAC. In post-hoc models, we found a significant interaction between age, CIS-R scores, and CAC (p=0.019), suggesting a stronger association in older individuals. Conclusions: Psychopathological symptoms were directly associated with coronary atherosclerosis in the ELSA-Brasil baseline. This association was evident after adjustment for age and sex, persisted in multivariate adjusted models, and seems to be stronger in older individuals.

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