Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Tzu-Pu Chang ◽  
Anand K. Bery ◽  
Zheyu Wang ◽  
Krisztian Sebestyen ◽  
Yu-Hung Ko ◽  
...  
Keyword(s):  
Propensity Scores ◽  
Stroke Risk ◽  
Cohort Analysis ◽  
Population Based ◽  
Specialty Care ◽  
National Database ◽  
Clinical Settings ◽  
Vestibular Disorder ◽  
Peripheral Vestibular Disorder ◽  
General Care

Abstract Objectives Isolated dizziness is a challenging stroke presentation in the emergency department, but little is known about this problem in other clinical settings. We sought to compare stroke hospitalizations after treat-and-release clinic visits for purportedly “benign dizziness” between general and specialty care settings. Methods This was a population-based retrospective cohort study from a national database. We included clinic patients with a first incident treat-and-release visit diagnosis of non-specific dizziness/vertigo or a peripheral vestibular disorder (ICD-9-CM 780.4 or 386.x [not 386.2]). We compared general care (internal medicine, family medicine) vs. specialty care (neurology, otolaryngology) providers. We used propensity scores to control for baseline stroke risk differences unrelated to dizziness diagnosis. We measured excess (observed>expected) stroke hospitalizations in the first 30 d (i.e., missed strokes associated with an adverse event). Results We analyzed 144,355 patients discharged with “benign dizziness” (n=117,117 diagnosed in general care; n=27,238 in specialty care). After propensity score matching, patients in both groups were at higher risk of stroke in the first 30 d (rate difference per 10,000 treat-and-release visits for “benign dizziness” 24.9 [95% CI 18.6–31.2] in general care and 10.6 [95% CI 6.3–14.9] in specialty care). Short-term stroke risk was higher in general care than specialty care (relative risk, RR 2.2, 95% CI 1.5–3.2) while the long-term risk was not significantly different (RR 1.3, 95% CI 0.9–1.9), indicating higher misdiagnosis-related harms among dizzy patients who initially presented to generalists after adequate propensity matching. Conclusions Missed stroke-related harms in general care were roughly twice that in specialty care. Solutions are needed to address this care gap.

Incidence, Epidemiology, and Outcomes of Pediatric Tracheostomy in the United States from 2000 to 2012

2018 ◽  
Vol 160 (2) ◽  
pp. 332-338 ◽  
Author(s):  
R. Grant Muller ◽  
Madhu P. Mamidala ◽  
Samuel H. Smith ◽  
Aaron Smith ◽  
Anthony Sheyn
Keyword(s):  
United States ◽  
Cohort Analysis ◽  
Secondary Analysis ◽  
The United States ◽  
Population Based ◽  
Geographic Region ◽  
Hospital Charges ◽  
National Database ◽  
Discharge Data ◽  
Procedure Codes

Objectives To investigate national and regional variations in pediatric tracheostomy rates, epidemiology, and outcomes from 2000 to 2012. Study Design Retrospective cohort analysis. Setting Previous research with the 1997 edition of the Kids’ Inpatient Database (KID), a national database of pediatric hospital discharge data, demonstrated that rates and outcomes of pediatric tracheostomy vary among US geographic regions. The KID has since been released an additional 5 times, increasing in size with successive editions. Subjects and Methods Patients ≤18 years old with procedure codes for permanent or temporary tracheostomy from 2000 to 2012 were included. Primary outcome was a weighted population-based rate of tracheostomy stratified by year. Secondary analysis included epidemiologic characteristics and outcomes stratified by year and geographic region. Results A weighted total of 24,354 cases was analyzed. Population-based tracheostomy rates decreased from 6.8 ± 0.2 (mean ± SD) tracheostomies per 100,000 child-years in 2000 to 6.0 ± 0.2 in 2012. Minorities increased from 53.3% in 2000 to 56.4% in 2012. Patients experienced increased procedures, diagnoses, length of stay, and hospital charges with time. From 2000 to 2012, rates and outcomes varied by US geographic region. Mortality during hospitalization (8%) did not vary by year, patient age, region, or sex. Conclusions Pediatric tracheostomy is associated with variation in incidence, epidemiology, and hospitalization outcomes in the United States from 2000 to 2012. While rates of pediatric tracheostomy decreased, patients became increasingly medically complicated and ethnically diverse with outcomes varying according to geographic region.

scholarly journals Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Survey

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 214-215
Author(s):  
Rahul Sharma ◽  
Anil Lalwani ◽  
Justin Golub
Keyword(s):  
Hearing Loss ◽  
Pure Tone ◽  
Population Level ◽  
Population Based ◽  
National Database ◽  
Cross Sectional ◽  
Adult Lifespan ◽  
Pure Tone Average ◽  
Age Related ◽  
Public Datasets

Abstract The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

Stroke Risk Before and After Central Retinal Artery Occlusion: a Population-based Analysis

Ophthalmology ◽  
2021 ◽  
Author(s):  
Kevin D. Chodnicki ◽  
Laurel B. Tanke ◽  
Jose S. Pulido ◽  
David O. Hodge ◽  
James P. Klaas ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Population Based ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Before And After ◽  
Retinal Artery

scholarly journals In utero exposure to ritodrine during pregnancy and risk of autism in their offspring until 8 years of age

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jungsoo Chae ◽  
Geum Joon Cho ◽  
Min-Jeong Oh ◽  
KeonVin Park ◽  
Sung Won Han ◽  
...  
Keyword(s):  
National Health ◽  
Screening Program ◽  
Hazard Analysis ◽  
Population Based ◽  
In Utero ◽  
National Database ◽  
Rank Test ◽  
In Utero Exposure ◽  
Exposure Group ◽  
Increased Risk

AbstractBeta-2 adrenergic receptor (B2AR) agonists, used as asthma treatments and tocolytics during pregnancy, have recently been reported to be associated with autism in their offspring. However, the particular link between autism and ritodrine, a common type of B2AR agonist used solely as tocolytics, has never been substantiated with any nationwide database. Thus, we aimed to examine the association between in utero exposure of ritodrine and the risk of autism in their offspring using a national database. This population-based cohort study was conducted by merging the Korea National Health Insurance claims database and National Health Screening Program for Infants and Children database. These databases included all women who had delivered singleton between January 2007 and December 2008 in Korea. Out of the total 770,016 mothers, 30,959 (4.02%) were exposed to ritodrine during pregnancy, and 5583 (0.73%) of their children were identified as having autism, defined until 8 years of age. According to our analysis, the overall cumulative incidence of autism up to 8 years was 1.37% in ritodrine exposure group and 0.70% in ritodrine non-exposure group (p < 0.05, log-rank test). By Cox proportional hazard analysis, use of ritodrine in preterm birth was associated with significantly higher hazard of autism [adjusted hazard ratio: 1.23, 95% CI 1.04–1.47], after adjusting for confounding variables including maternal age, parity, cesarean section, preterm labor, steroid use, birth weight, gender, and preeclampsia. Thus, in utero exposure to ritodrine was associated with an increased risk of autism in their offspring.

Abstract P672: Black White Disparity in Multiple Risk Factors is Increased in Older Young Adults

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Prachi Mehndiratta ◽  
Kathleen Ryan ◽  
Adeolu Morawo ◽  
Seemant Chaturvedi ◽  
Carolyn A Cronin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Stroke Risk ◽  
Reference Group ◽  
Population Based ◽  
Multiple Risk Factors ◽  
Stroke In Young Adults ◽  
Multiple Risk ◽  
The Relationship ◽  
Control Study

Background: Stroke in young adults constitutes 15-18% of all ischemic strokes. Vascular risk factors contribute to stroke risk in young adults particularly older young adults. Few studies have addressed Black White differences in risk, stratified by age. We evaluated the prevalence of risk factors in the younger young (less than 40 years) vs. the older young adults (40 and above). Methods: A population based case control study with 1034 cases and 1091 controls, ages 15-49 was used to investigate the relationship between risk factors (DM, HTN, Smoking and Obesity) and stroke. Groups were defined by the number of risk factors (RF) among cases and controls : no risk factors (ref group), one RF, two RF, three RF and four RF. Prevalence of risk factors was determined in the entire population and stratified by age, sex and race. Logistic regression was used to determine odds of stroke based on the number of risk factors compared to the reference group. Results: The percent of cases with three or more risk factors was compared in different subgroups: ages 15-39 vs. 40-49 was 8.4 vs. 21.6, women vs. men was 15.6 vs. 18.6 and White vs. Black was 12.3 vs. 22.7. Among cases 40 years and older, Blacks were 3 times more likely than Whites (5.9 vs. 2) to have four or more risk factors.Across all age, race and sex subgroups, the odds of having a stroke increased exponentially with an increase in the number of risk factors. Conclusion: Blacks are more likely to have multiple risk factors than Whites. This difference is accentuated in those 40 years and older. Targeting young adults with multiple risk factors for preventive interventions would address a root case of excess stroke risk especially among Blacks.

Abstract 309: Vasovasorum Volume Can Be Measured by Contrast-Enhanced 3D Carotid Duplex Ultrasound: Concept and Design of a Novel Method for Predicting Stroke Risk in Patients With Carotid Artery Stenosis

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Isibor J Arhuidese ◽  
Alexander Nodel ◽  
Umair Qazi ◽  
Diana Call ◽  
Bruce Perler ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Duplex Ultrasound ◽  
Population Based ◽  
Severe Stenosis ◽  
Asymptomatic Patients ◽  
Grant Support ◽  
Contrast Enhanced ◽  
Novel Method ◽  
Preliminary Study ◽  
Selection For

Introduction: Stroke remains a leading cause of death and disability. The reliance on the occurrence of symptoms and degree of stenosis for selecting patients with carotid stenosis for intervention is not ideal because it is often seen that patients with severe stenosis remain asymptomatic while many patients with moderate stenosis experience stroke. Furthermore, the majority of patients are asymptomatic until they experience stroke. It is known that intimal neovascularization flourishes as atherosclerotic disease progresses; however no technique in current use adequately correlates neovascularization to stroke risk. Objective: With seed grant support from the Society for Vascular Surgery Foundation we are executing a study based on our hypothesis that Vasovasorum Volume (VVV) measured using CE-3DCDU as a valid tool for mapping stroke risk. Method: We are recruiting symptomatic and asymptomatic patients adjudged to have >50% and >70% stenosis respectively on routine duplex ultrasound. Vasovasorum volume is measured using CE-3DCDU in patients who are eligible for carotid endarterectomy. Plaque removed during surgery is marked, decalcified and immunostained with CD34. Thereafter, VVV is measured in the excised plaque using 3D reconstruction histometry. We then evaluate the reliability and accuracy of CE-3DCDU in relation to the histopathology and compare VVV in symptomatic and asymptomatic patients. Results: The preliminary study included six patients and the results show that VVV measurement in carotid ultrasound and histopathology is feasible and reproducible (Figures 1 and 2). Conclusion: Vasovasorum volume is a promising predictor of stroke risk. By identifying patients who are truly at high risk for stroke, VVV measured by CE-3DCDU will aid precise patient selection for intervention, thus prevent stroke, save lives, limit disability and expend health care resources in an informed manner. The next phase of this project involves the establishment of efficacy and a population based multi-center clinical trial to generate evidence required to incorporate VVV measured using CE-3DCDU into clinical practice.

Abstract W MP66: Rates of Ischemic Stroke after Intracranial Hemorrhage in a Population-Based Sample of Patients with Atrial Fibrillation

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Michael P Lerario ◽  
Gino Gialdini ◽  
Daniel Lapidus ◽  
Mesha Shaw ◽  
Babak Navi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Anticoagulant Therapy ◽  
Stroke Risk ◽  
Hazard Analysis ◽  
Large Population ◽  
Population Based ◽  
Administrative Claims ◽  
Index Visit

Introduction: Patients with atrial fibrillation (AF) who experience intracranial hemorrhage (ICH) often cannot tolerate anticoagulant therapy and presumably face a higher risk of thromboembolism. However, there are little population-based data on long-term rates of stroke after ICH in patients with AF. Methods: Using validated diagnosis codes and administrative claims data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at their first encounter with a recorded diagnosis of AF. We excluded patients with diagnoses of stroke or ICH prior to their index visit or a diagnosis of stroke at the index visit. A time-varying covariate was used to account for ICH (intracerebral or subarachnoid hemorrhage) at the index visit or during follow-up. Kaplan-Meier survival statistics were used to calculate cumulative rates of stroke, and Cox proportional hazard analysis was used to evaluate the relationship between incident ICH and stroke while adjusting for the CHA 2 DS 2 VASc score. Results: During a mean 3.2 years of follow-up among 2,376,207 patients with AF, 25,243 (1.06%) developed ICH and 93,183 (3.92%) developed stroke. The cumulative 1-year rate of stroke was 6.50% (95% CI, 6.06-6.96%) after ICH versus 2.22% (95% CI, 2.20-2.24) in those without ICH. ICH remained associated with higher stroke risk after adjusting for the CHA 2 DS 2 VASc score (HR, 2.29; 95% CI, 2.18-2.40). Among patients with ICH, stroke risk rose in step with the CHA 2 DS 2 VASc score. Conclusions: In a large population-based cohort, patients with AF faced a substantially higher risk of stroke after ICH. This risk rose proportionally with increasing CHA 2 DS 2 VASc score. These findings point to patients with AF and ICH as a vulnerable population who may especially benefit from therapeutic alternatives to anticoagulant therapy for preventing thromboembolism in AF.

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