scholarly journals Predictors of in-Hospital Mortality Among Suspected Stroke Patients, Mashhad, Iran: An Application of Autologistic Regression Model

2021 ◽  
Author(s):  
Ali Hadianfar ◽  
Payam Sasannezhad ◽  
Eisa nazar ◽  
Azadeh Saki ◽  
Razieh Yousefi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Regression Model ◽  
Stroke Mortality ◽  
Stroke Patients ◽  
Autologistic Regression ◽  
Related Factors ◽  
Historical Cohort ◽  
Geographical Variations ◽  
Suspected Stroke

Abstract Background: Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS), and transport delays have been documented worldwide to affect stroke outcomes significantly. Therefore, this study examines whether there are spatial variations in in-hospital mortality among suspected stroke patients transferred by EMS and attempts to determine its related factors using the auto logistic regression model.Methods: In this historical cohort study, suspected stroke patients transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 and March 2019 were included. Using emergency mission IDs, the baseline EMS data were integrated with the follow-up hospital records. The autologistic regression model was applied to examine the possible geographical variations in in-hospital mortality and its related factors. All analysis was carried out by SPSS version 16 and R 4.0.0 at the significant level of 0.05. Results: 1,222 suspected stroke patients were included in this study, and the in-hospital mortality rate was 14.2%. Overall in-hospital stroke mortality was related to age, accessibility rate of an ambulance, screening time, and length of stay (p<0.05). After stratifying by sex, we observed that mortality in men was related to age and length of stay, whereas, in women, variables of age, length of stay, accessibility rate of an ambulance, and screening time had a significant effect on in-hospital mortality among suspected stroke patients (p<0.05).Conclusion: Our results showed considerable geographical variations in in-hospital stroke mortality in Mashhad neighborhoods. Also, age- and sex-adjusted results from this study highlight the direct association between accessibility rate of an ambulance, screening time and length of stay, and in-hospital stroke mortality. The prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.

scholarly journals Predictors of In-Hospital Mortality Among Suspected Stroke Patients, Mashhad, Iran: An Application of Autologistic Regression Model

2021 ◽  
Author(s):  
Mohammad Taghi Shakeri ◽  
Isa Nazar ◽  
Azadeh Saki ◽  
Razieh Yousefi ◽  
Ali Hadianfar ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Regression Model ◽  
Stroke Mortality ◽  
Stroke Patients ◽  
Autologistic Regression ◽  
Related Factors ◽  
Historical Cohort ◽  
Geographical Variations ◽  
Suspected Stroke

Abstract Background Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS), and transport delays have been documented worldwide to affect stroke outcomes significantly. Therefore, this study examines whether there are spatial variations in in-hospital mortality among suspected stroke patients transferred by EMS and attempts to determine its related factors using the auto logistic regression model. Methods In this historical cohort study, suspected stroke patients transferred to Ghaem Hospital of Mashhad by the EMS from April 2018 to March 2019 were included. Using emergency mission IDs, the baseline EMS data were integrated with the follow-up hospital records. The autologistic regression model was applied to examine the possible geographical variations in in-hospital mortality and its related factors. All analysis was carried out by SPSS version 16 and R 4.0.0 at the significant level of 0.05. Results 1,222 suspected stroke patients were included in this study, and the in-hospital mortality rate was 14.2%. Overall in-hospital stroke mortality was related to age, accessibility rate of an ambulance, screening time, and length of stay (p < 0.05). After stratifying by sex, we observed that mortality in men was related to age and length of stay, whereas, in women, variables of age, length of stay, accessibility rate of an ambulance, and screening time had a significant effect on in-hospital mortality among suspected stroke patients (p < 0.05). Conclusion Our results showed considerable geographical variations in in-hospital stroke mortality in Mashhad neighborhoods. Also, age- and sex-adjusted results from this study highlight the direct association between accessibility rate of an ambulance, screening time and length of stay, and in-hospital stroke mortality. The prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.

Abstract P397: Outcomes in Acute Ischemic Stroke Patients Presenting With Impaired Level of Consciousness

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ayham Alkhachroum ◽  
Antonio Bustillo ◽  
Negar Asdaghi ◽  
Erika T Marulanda-londono ◽  
Carolina M Gutierrez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Early Recovery ◽  
Hospital Size ◽  
Stroke Registry ◽  
Level Of Consciousness

Background: Impaired level of consciousness (LOC) on presentation after acute ischemic stroke (AIS) may affect outcomes and the decision to withdraw life-sustaining treatment (WLST). We aim to investigate the outcomes and their trends after AISby the LOC on stroke presentation. Methods: We studied 238,989 cases with AIS in the Florida Stroke Registry from 2010-2019. Pearson chi-squared and Kruskall-Wallis tests were used to compare descriptive statistics. A multivariable-logistic regression with GEE accounted for basic demographics, comorbidities, stroke severity, location, hospital size and teaching status. Results: At stroke presentation, 32,861 (14%) cases had impaired LOC (mean age 77, 54% women, 60 white%, 19% Black, 16% Hispanic). Compared to cases with preserved LOC, impaired cases were older (77 vs. 72 years old), more women (54% vs. 48%), had more comorbidities, greater stroke severity on NIHSS ≥ 5 (49% vs. 27%), higher WLST rates (3% vs. 0.6%), and greater in-hospital mortality rates (9% vs. 3%). In our adjusted model however, no significant association was found between impaired LOC and in-hospital mortality, or length of stay. Those with preserved LOC were more likely discharged home/rehab (OR 0.7, 95%CI 0.6-0.8, p<0.0001) and more likely to ambulate independently (OR 0.7, 95%CI 0.6-0.9, p=0.001). Trend analysis (2010-2019) showed decreased mortality, increased length of stay, and increased rates of discharge to home/rehab in all irrespective of LOC status. Conclusion: In this large multicenter registry, AIS cases presenting with impaired LOC had more severe strokes at presentation. Although LOC was not associated with significantly worse in-hospital morality, it was associated with higher rates of WLST and more disability among survivors. Future efforts should focus on biomarkers of LOC that discriminates the potential for early recovery and reduced disability in acute stroke patients with impaired LOC.

scholarly journals Regional Variation in Hospital Mortality, Length of Stay and Cost of Ischemic Stroke Patients in Alberta

2014 ◽  
Vol 17 (7) ◽  
pp. A502
Author(s):  
A. Ohinmaa ◽  
Y. Zheng ◽  
T. Jeerakathil ◽  
N.X. Thanh ◽  
U. Hakkinen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Regional Variation ◽  
Stroke Patients

PP11 The use of prehospital 12-lead electrocardiograms in acute stroke patients

2019 ◽  
Vol 36 (1) ◽  
pp. e5.1-e5
Author(s):  
Scott Munro ◽  
Debbie Cooke ◽  
Mark Joy ◽  
Adam Smith ◽  
Kurtis Poole ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Stroke ◽  
Secondary Analysis ◽  
Vital Role ◽  
Current Guideline ◽  
Hospital Data ◽  
Stroke Patients ◽  
Time Intervals ◽  
Suspected Stroke ◽  
Clinical Records

BackgroundEmergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke, but this recommendation is based on expert consensus, rather than robust evidence.The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received.MethodsA multicentre retrospective cohort study was undertaken.The data collection period spanned from 29/12/2013–30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number.ResultsPHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.30, 95% CI 1.01 to 1.66, p=0.04) and in-hospital mortality (aOR 1.83, 95% CI 1.26–2.67, p=0.002). There was no association between PHECG and administration of thrombolysis (aOR 1.06, 95% CI 0.75–1.52, p=0.73).Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.32) or median door-to-needle time (median 46 min vs 48 min, p=0.37) were observed.ConclusionThis is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke.

scholarly journals The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Gabby Elbaz-Greener ◽  
Guy Rozen ◽  
Shemy Carasso ◽  
Fabio Kusniec ◽  
Merav Yarkoni ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Regression Model ◽  
Coronary Artery Bypass ◽  
Real World ◽  
Artery Bypass ◽  
Bypass Grafting

Background: The association between Body Mass Index (BMI) and clinical outcomes following coronary artery bypass grafting (CABG) remains controversial. Our objective was to investigate the real-world relationship between BMI and in-hospital clinical course and mortality, in patients who underwent CABG.Methods: A sampled cohort of patients who underwent CABG between October 2015 and December 2016 was identified in the National Inpatient Sample (NIS) database. Outcomes of interest included in-hospital mortality, peri-procedural complications and length of stay. Patients were divided into 6 BMI (kg/m2) subgroups; (1) under-weight ≤19, (2) normal-weight 20–25, (3) over-weight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) extremely obese ≥40. Multivariable logistic regression model was used to identify predictors of in-hospital mortality. Linear regression model was used to identify predictors of length of stay (LOS).Results: An estimated total of 48,710 hospitalizations for CABG across the U.S. were analyzed. The crude data showed a U-shaped relationship between BMI and study population outcomes with higher mortality and longer LOS in patients with BMI ≤ 19 kg/m2 and in patients with BMI ≥40 kg/m2 compared to patients with BMI 20–39 kg/m2. In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 were found to be independent predictors of mortality.Conclusions: A complex, U-shaped relationship between BMI and mortality was documented, confirming the “obesity paradox” in the real-world setting, in patients hospitalized for CABG.

scholarly journals P080: What is the impact of post-intubation hypotension on mortality and in-hospital length of stay?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S92
Author(s):  
D. Lachance-Perreault ◽  
J. Turgeon ◽  
V. Boucher ◽  
M. Émond
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Vital Signs ◽  
Mortality Rates ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Historical Cohort ◽  
Resuscitation Room ◽  
Post Intubation ◽  
The Impact

Introduction: Hypotension is known to severely impact the prognosis of patients in need of acute care. Endotracheal intubation (EI) is a procedure that is often used in the emergency room for patients with severe conditions. Post-intubation hypotension (PHI) is a well-known adverse effect of EI, although the impact of PHI on mortality is still unclear. The objective of this study was therefore to evaluate the association between post-intubation hypotension (PIH) and in-hospital mortality rates and length of stay (LOS). Methods: Design: A historical cohort of patients admitted in a university-affiliated emergency department (ED) between 06/2011 and 05/2016 was constituted. Population: Patients aged ≥16 were included if pre-EI vital signs were available, if their intubation was performed in the resuscitation room, if no surgical access was needed and if EI was performed in ≤3 attempts. Measures: All clinical data including vitals were prospectively recorded using the software ReaScribe. Hypotension was defined as a systolic blood pressure ≤90 mmHg. The occurrence of PIH was assessed at 5, 15, 30 minutes and any time after intubation. Main outcomes were in-hospital mortality and hospital length of stay. Analyses: Univariate and multivariate analyses assessed the relation between PHI and outcomes. Results: A total of 497 patients were included in our analyses. Of these patients, 63 (12.7%) suffered from PIH at 5 minutes, 120 (24,1%) at 15 minutes, 168 (33,8%) at 30 minutes and 209 (42%) at any moment after intubation. Mortality rates were 42.9% (n = 27), 35.8% (n = 43), 33.9% (n = 57) and 30.6%(n = 64) for patients who presented PIH at the 4 time periods, respectively, while 26.74% patients died in the normotensive group. PIH at 5 (p = 0.006), 15 (p = 0.04) and 30 minutes (p = 0.05) was associated with a significant increase in overall post-intubation mortality. Mean LOS for patients who suffered from PIH was 16.7, 18.9, 17.3, 17.4 days compared to 19.5 (p = 0.22) days for the normotensive group. Conclusion: Early post-intubation hypotension at 5 minutes was strongly associated with an increased mortality. As for the in-hospital length of stay, PIH was not associated with an increased LOS. Our results show that PIH within 30 minutes of intubation is associated with an increased mortality rate and should therefore be aggressively treated or prevented.

scholarly journals Mortality and hospital stay due to stroke in elderly people in Brazil (2008-2019): a time series study

2021 ◽  
Author(s):  
Thiago Cavalcanti Leal ◽  
Carlos Dornels Freire de Souza ◽  
Leonardo Feitosa da Silva ◽  
João Paulo Silva de Paiva ◽  
Lucas Gomes Santos ◽  
...  
Keyword(s):  
Time Series ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Regression Model ◽  
Hospital Stay ◽  
Elderly People ◽  
Annual Percent Change ◽  
Average Hospital ◽  
Percent Change

Background: Stroke is the second leading cause of mortality worldwide, being preceded only by ischemic heart diseases, 85% of these deaths occur in developing countries. Objective: To analyze the temporal behavior of elderly mortality due to stroke in Brazil, regions and federation units from 2008 to 2019. Methods: Ecological study of time series using Brazil, its regions and federation units as units of analysis. The following categories were collected on the DATASUS online platform :, :, i) length of stay, ii) average length of stay (days), iii) number of deaths, and hospital mortality rate from 2008 to 2019 for Brazil, regions and federative units. In the analyzes, the inflection point regression model was used, the 95% confidence interval and the significance level of 5% (joinpoint regression model) were adopted and the annual percentage change (Annual Percent Change - APC) was calculated. and the entire period (Average Annual Percent Change - AAPC). Results: As for Brazil, there was an average of 7.5 days per hospital stay and a hospital mortality rate corresponding to 16.6%. Among the regions, the highest gross numbers were evidenced in the Southeast with 4427093 days of stay, 7.73 days on average of stay and 99753 deaths. A decrease was observed only in the hospital mortality rate in the South (AAPC: -1.3 CI: -1.9 to -0.7), Southeast (AAPC: -1.3 CI: -1.7 to -0.9) and Northeast (AAPC: -0.7 CI: -1.4 to -0.0) and the average hospital stay for the Southeast (AAPC: -0.7 CI: -1.3 to -0.1). Conclusion: There was a heterogeneous behavior of the variables related to the mortality of elderly people due to stroke in Brazil, in parallel to the stationary behavior of the average hospitalization observed in the regions and units of the federation with the exception of the Southeast, which showed a decrease in the average days spent in study period.

scholarly journals Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Significant Difference ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background This work was to study the prehospital time among suspected stroke patients who were transported by an emergency medical service (EMS) system using a national database. Methods National EMS database of suspected stroke patients who were treated by EMS system across 77 provinces of Thailand between January 1, 2015, and December 31, 2018, was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance, and distance to the scene) and prehospital time (i.e., dispatch, activation, response, scene, and transportation time) were extracted. Time parameters were also categorized according to the guidelines. Results Total 53,536 subjects were included in the analysis. Most of the subjects were transported during 06.00-18.00 (77.5%) and were 10 km from the ambulance parking (80.2%). Half of the subjects (50.1%) were served by advanced life support (ALS) ambulance. Median total time was 29 min (IQR 21, 39). There was a significant difference of median total time among ALS (30 min), basic (27 min), and first responder (28 min) ambulances, Holm P = 0.009. Although 91.7% and 88.3% of the subjects had dispatch time ≤ 1 min and activation time ≤ 2 min, only 48.3% had RT ≤ 8 min. However, 95% of the services were at the scene ≤ 15 min. Conclusion Prehospital time from EMS call to hospital was approximately 30 min which was mainly utilized for traveling from the ambulance parking to the scene and transporting patients from the scene to hospitals. Even though only 48% of the services had RT ≤ 8 min, 95% of them had the scene time ≤ 15 min.

scholarly journals Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan

2021 ◽  
Author(s):  
Yusuke Katayama ◽  
Tetsuhisa Kitamura ◽  
Kosuke Kiyohara ◽  
Kenichiro Ishida ◽  
Tomoya Hirose ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Regression Model ◽  
Traffic Accident ◽  
Logistic Regression Model ◽  
Cardiopulmonary Arrest ◽  
Population Based ◽  
Fluid Administration ◽  
Secondary Outcome

Abstract Purpose The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method. Methods The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene. Results During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045). Conclusion In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.

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