scholarly journals Association Between Gastrointestinal Bleeding With Clinical Outcome On Acute Ischemic Stroke Patient

2019 ◽  
Author(s):  
Lisda Amalia ◽  
Rico Defryantho ◽  
Ida Parwati ◽  
Ahmad Rizal Ganiem ◽  
Ramdan Panigoro
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Gastrointestinal Bleeding ◽  
Acute Ischemic Stroke ◽  
Stroke Patient ◽  
Ischemic Stroke Patient ◽  
Stroke Patients ◽  
Acute Ischemic Stroke Patient ◽  
Risk Of Death

Abstract Background Gastrointestinal bleedingis one of the complication of acute ischemic stroke and cause of increased mortality and length of stay. This is caused by a delay in the administration of antiplatelet or anticoagulant.Objective.To find the association between gastrointestinal bleeding with clinical outcome in acute ischemic stroke patient.Methods.This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung for 4 months (November 2017-February 2018). Acute ischemic stroke patients that fulfill the inclusion and exclusion were observed while being inpatients to observe their mortality and length of stay.This study used univariat, bivariat, multivariat, and stratification analysis.Results. A total of 100 acute ischemic stroke patients were found, and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found most often in patient with gastrointestinal bleeding (20.8%/p=0.003).Median NIHSS score is higher (16 vs 7/p<0.001) and GCS score was lower (12 vs 15/p<0.001) in patients with gastrointestinal bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival (p = 0.021) and length of stay (p = 0.008). The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7 vs 22.5 times and 1.5 vs 2 times).Conclusion.Gastrointestinal bleeding had more increased mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.

scholarly journals HUBUNGAN PERDARAHAN GASTROINTESTINAL DENGAN LUARAN PASIEN STROKE ISKEMIK AKUT

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Rico Defryantho ◽  
Lisda Amalia ◽  
Ahmad Rizal ◽  
Suryani Gunadharma ◽  
Siti Aminah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Gastrointestinal Bleeding ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Exclusion Criteria ◽  
Risk Of Death ◽  
History Of ◽  
Gcs Score

     ASSOCIATION BETWEEN GASTROINTESTINAL BLEEDING WITH CLINICAL OUTCOME ACUTE ISCHEMIC STROKE PATIENTABSTRACTIntroduction: Gastrointestinal bleeding associated by the delay in the administration of antiplatelet and anticoagulant, thus affected the clinical outcome and patient treatment.Aims: To find the association between gastrointestinal bleeding and clinical outcome in acute ischemic stroke patient.Methods: This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung in November 2017 to February 2018. Acute ischemic stroke patients that fulfill the inclusion and exclusion criteria were observed while being treated in the ward and the survival rate and length of stay were studied. This study used univariate, bivariate, multivariate, and stratification analysis.Results: In the study period, 100 acute ischemic stroke patients were found and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found in patient with gastrointestinal bleeding (20.8%). Median NIHSS score was higher (16 vs 7) and GCS score was lower (12 vs 15) in patients with bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival and length of stay. The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7  vs  22.5 times and 1.5 vs 2 times).Discussion: Ischemic stroke with gastrointestinal bleeding had higher mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.Keyword: Acute ischemic stroke, gastrointestinal bleeding, length of stay, mortalityABSTRAKPendahuluan: Perdarahan gastrointestinal berhubungan dengan penundaan terapi antiplatelet atau antikoagulan, sehingga berpengaruh terhadap luaran dan tata laksana pasien.Tujuan: Mengetahui hubungan perdarahan gastrointestinal dengan luaran pasien stroke iskemik akut.Metode: Penelitian prospektif observasional terhadap pasien stroke iskemik akut di RSUP Dr. Hasan Sadikin, Bandung pada bulan November 2017 hingga Februari 2018. Pasien stroke iskemik akut yang memenuhi kriteria inklusi dan eksklusi diobservasi selama perawatan untuk mengetahui survival dan lama perawatan di rumah sakit. Analisis statistik yang digunakan adalah univariat, bivariat, multivariat, dan stratifikasi.Hasil: Selama periode penelitian didapatkan 100 subjek stroke iskemik akut dengan 24 subjek mengalami perdarahan gastrointestinal. Riwayat ulkus peptikum/perdarahan gastrointestinal sebelumnya sebanyak 20,8% pada perdarahan gastrointestinal. Median skor NIHSS lebih tinggi (16 vs 7) dan skor GCS lebih rendah (12 vs 15) pada perdarahan. Analisis multivariat didapatkan perdarahan gastrointestinal memiliki hubungan signifikan dengan survival dan lama perawatan. Berdasarkan analisis stratifikasi subjek dengan infeksi yang kemudian mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih rendah dibandingkan subjek tanpa infeksi kemudian mengalami perdarahan gastrointestinal (1,7 vs 22,5 kali dan 1,5 vs 2 kali).Diskusi: Stroke iskemik akut yang mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih tinggi dibandingkan tanpa perdarahan gastrointestinal.Kata kunci: Lama perawatan, mortalitas, perdarahan gastrointestinal, stroke iskemik akut

Abstract T P308: Does Hospitalist Directed Care Reduce The Length Of Stay For Acute Ischemic Stroke Patients And Improve Adherence To The “Get With The Guidelines” Inpatient Quality Measures?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Christian Sanchez ◽  
Ahmed A Malik ◽  
Erlinda Abantao ◽  
Olive Sanchez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Family Practice ◽  
Quality Measures ◽  
Stroke Patients ◽  
Thromboembolism Prophylaxis ◽  
Acute Ischemic Stroke Patient ◽  
Significant Difference ◽  
Get With The Guidelines

Background: Hospitalist directed care has shown significant association with improved lengths of stay with improvements in outcomes in several acute conditions. The hospitalist effect has not been studied in acute ischemic stroke management. Objective: To identify acute ischemic stroke patients admitted under a hospitalist, internist, family practice physician, or a specialist and compare the length of stay, discharge outcome, and adherence to the “Get with the Guidelines” (GWTG) stroke performance measures prior to discharge. Methods: We identified consecutive acute ischemic stroke patients over a 4-year period (June 2010-June 2014) from a private Gold Plus Target Stroke Honor Roll primary stroke center. We categorized all stroke admissions according to admitting physicians - hospitalist, internist, family practice, or specialty physician directed care. We collected demographics, risk factors and discharge outcomes based on the modified Rankin Scale (mRS). We analyzed all of the GWTG stroke inpatient quality measures (venous thromboembolism prophylaxis, statin on discharge, anthithrombotic by end of day 2, antithrombotic medication on discharge, atrial fibrillation discharged on anticoagulant) and compared rate of deficiencies between the four groups of admitting physicians. Results: A total of 1584 patients [mean age (± SD) 68.6±13.7 years; 55.6% men] were admitted with acute ischemic stroke. There was no statistically significant difference in length of stay between the 4 groups (p=0.4). There was a significant difference in the GTWG inpatient quality measures with the hospitalist group having the lowest rates of deficiencies seen with 5% of their admissions (p=0.03), and the internists have the highest rate of deficiencies with 16% of their admissions (p=0.01). The most common deficiency was not prescribing a statin at discharge (56% of total fallouts). There was no difference in poor outcomes on discharge (mRS 3-6) (p=0.2). Conclusions: There is a significant improvement in adherence to the GWTG inpatient stroke measures when an acute ischemic stroke patient is admitted under the care of a hospitalist. Prospective databases are recommended to evaluate if this leads to better long term outcomes.

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