ACCURACY OF ALLEN SCORE IN PREDICTING STROKE TYPE

BackgroundAround 25% of patients who had a stroke do not present with typical ‘face, arm, speech’ symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives).MethodWe performed a systematic search of MEDLINE, EMBASE, CINAHL and PubMed from 1995 to August 2020 using key terms: stroke, EMS, paramedics, identification and assessment. Studies included: patients who had a stroke or patient records; ≥18 years; any stroke type; prehospital assessment undertaken by health professionals including paramedics or technicians; data reported on prehospital diagnostic accuracy and/or presenting symptoms. Data were extracted and study quality assessed by two researchers using the Quality Assessment of Diagnostic Accuracy Studies V.2 tool.ResultsOf 845 studies initially identified, 21 observational studies met the inclusion criteria. Of the 6934 stroke and Transient Ischaemic Attack patients included, there were 1774 (26%) false negative patients (range from 4 (2%) to 247 (52%)). Commonly documented symptoms in false negative cases were speech problems (n=107; 13%–28%), nausea/vomiting (n=94; 8%–38%), dizziness (n=86; 23%–27%), changes in mental status (n=51; 8%–25%) and visual disturbance/impairment (n=43; 13%–28%).ConclusionSpeech problems and posterior circulation symptoms were the most commonly documented symptoms among stroke presentations that were not correctly identified by EMS (false negatives). However, the addition of further symptoms to stroke screening tools requires valuation of subsequent sensitivity and specificity, training needs and possible overuse of high priority resources.

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Spatiotemporal based table tennis stroke-type assessment

Signal Image and Video Processing ◽

10.1007/s11760-021-01893-7 ◽

2021 ◽

Author(s):

Kadir Aktas ◽

Mehmet Demirel ◽

Marilin Moor ◽

Johanna Olesk ◽

Cagri Ozcinar ◽

...

Keyword(s):

Table Tennis ◽

Stroke Type

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Abstract P114: White Coat Effect is Common Among Stroke Survivors

Hypertension ◽

10.1161/hyp.70.suppl_1.p114 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Adriana Morell ◽

Munachi Okpala ◽

Sean Savitz ◽

Anjail Z Sharrief

Keyword(s):

Blood Pressure ◽

Recurrent Stroke ◽

White Coat ◽

Uncontrolled Hypertension ◽

Stroke Survivors ◽

White Coat Effect ◽

Chi Squared ◽

Stroke Type ◽

Ischemic Attack ◽

Univariate Analyses

Background and Purpose: Among stroke survivors, uncontrolled hypertension is a major risk factor for recurrent stroke. Blood pressure (BP) medication titration often relies on office BP measures, which may be inaccurate due to the white coat effect (WCE). We sought to determine the prevalence of the WCE in stroke survivors and to determine whether clinical and demographic factors were associated with WCE. Methods: We followed ischemic and hemorrhagic stroke and transient ischemic attack patients with prior hypertension presenting to our stroke clinic for a BP study. Sitting BP was obtained by a medical assistant using an office automated BP machine (OABP). Patients also underwent BP measurement using BPtru, an automated machine that measures and averages five BPs with the patient alone in a room. BPtru approximate BPs obtained by the gold standard ambulatory blood pressure machine. Systolic BP (SBP) obtained by BPtru was subtracted from that obtained by OABP. WCE was defined as SBP difference ≥ 10mmHg. Uncontrolled BP was defined as SBP ≥ 135 mmHg by BPtru or ≥ 140 mmHg by OABP. We used student t-tests (continuous) and chi-squared or Fischer’s exact tests (categorical) for univariate analyses. Results: Of 94 patients, mean age was 60 (SD 12), 60.6% were male, 26.6% were Non-Hispanic White, 46.8% were Black, and 23.4% were Hispanic. Systolic OABP was 13.2 mmHg (SD 19.3) higher than BPtru SBP (student t-test; p <0.001). WCE was present in 58.5 % of participants and BP was misclassified as uncontrolled in 21.2%. In univariate analyses, age (p = 0.14), sex (p = 0.78), race (0.07), stroke type (0.92), body mass index (p = 0.65), and tobacco use (p = 0.35) were not significantly associated with presence of WCE. The presence of normal SBP by OABP was associated with a decreased likelihood of WCE (p = 0.006). Conclusions: Among hypertensive stroke patients following in a clinic, WCE was highly prevalent and one-fifth of patients were misclassified as uncontrolled. Neither race nor other previously described predictors of WCE were associated with WCE in this study. Our findings suggest that in patients with elevated office BP, findings should be confirmed with an automated machine like BPtru in order to avoid over-titration of medication or incorrect assessment of BP control.

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ADL Outcome of Stroke by Stroke Type and Time from Onset to Admission to a Comprehensive Inpatient Rehabilitation Ward

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106110 ◽

2021 ◽

Vol 30 (12) ◽

pp. 106110

Author(s):

Masanori Matsubara ◽

Shigeru Sonoda ◽

Makoto Watanabe ◽

Yuko Okuyama ◽

Hideto Okazaki ◽

...

Keyword(s):

Inpatient Rehabilitation ◽

Rehabilitation Ward ◽

Stroke Type

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Abstract P69: Clinical and Demographic Characteristics Associated With Cognitive Recovery During Stroke Inpatient Rehabilitation

Stroke ◽

10.1161/str.52.suppl_1.p69 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Seema Aggarwal ◽

Xu Zhang ◽

Dorothea Parker ◽

Shayandokht Taleb ◽

joseph wozny ◽

...

Keyword(s):

Regression Analysis ◽

Ischemic Stroke ◽

Social Interaction ◽

Problem Solving ◽

Inpatient Rehabilitation ◽

Cognitive Recovery ◽

Nihss Score ◽

Cognitive Improvement ◽

Stroke Type ◽

Interaction Problem

Introduction: We examined patient characteristics associated with cognitive improvement during inpatient rehabilitation. Methods: This was a retrospective review of clinical data from inpatient stroke rehabilitation units collected from 9/2017- 8/2019. Multiple and logistic regressions were used to examine the relationship between demographics, vascular risk factors and cognitive Functional Independence Measure (FIM) change scores on comprehension, expression, social interaction, problem solving, and memory in stroke patients, adjusted for cognitive FIM scores on admission. Results: The study cohort consisted of 680 patients with a mean age of 68 ± 14 years and median hospital LOS of 15 days. The percentage of patients that improved on comprehension, expression, social interaction, problem solving, and memory FIM scores was 61%, 65%, 62%, 64%, and 64%, respectively. Multiple regression analysis indicated that predictors of cognitive recovery included hypertension, stroke type, age, and NIHSS score. Specifically, hypertension predicted significantly less improvement on problem solving FIM scores (p=.033). Intracerebral hemorrhage (ICH) predicted significantly greater improvement on comprehension and problem solving FIM scores as compared to ischemic stroke (p=.047, p=.032, respectively). Compared to age < 65, age ≥ 65 predicted less improvement on comprehension, expression, and memory FIM scores (p<.001, p=.003, p<.001, respectively). NIHSS scores ≥ 21 predicted less improvement on comprehension, expression and problem solving FIM scores than NIHSS scores < 20 (p=.013, p=.017, p=.005, respectively). Logistic regression analysis suggested that the odds of cognitive improvement (defined as at least three FIM score changes ≥2) for ICH was 1.7 times greater than ischemic stroke (95% CI 1.07-2.72; Table 1). Conclusion: Hypertension, stroke type, age, and NIHSS score have profound impacts on cognitive recovery in during inpatient rehabilitation.

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Stroke and status epilepticus: stroke type, type of status epilepticus, and prognosis

Seizure ◽

10.1016/s1059131102001437 ◽

2003 ◽

Vol 12 (1) ◽

pp. 23-27 ◽

Cited By ~ 46

Author(s):

NAZIRE AFSAR ◽

DILAVER KAYA ◽

SEVINC AKTAN ◽

CANAN AYKUT-BINGOL

Keyword(s):

Status Epilepticus ◽

Stroke Type

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Cerebral blood flow in stroke-type patients

Microvascular Anastomoses for Cerebral Ischemia ◽

10.1007/978-1-4612-9911-0_22 ◽

1978 ◽

pp. 241-265 ◽

Cited By ~ 3

Author(s):

G. Austin ◽

D. Laffin ◽

R. Vasudevan ◽

E. Lichter ◽

W. Hayward

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Stroke Type

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How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care

Cerebrovascular Diseases Extra ◽

10.1159/000449288 ◽

2016 ◽

Vol 6 (3) ◽

pp. 96-106 ◽

Cited By ~ 15

Author(s):

Joan Porter ◽

Luke Mondor ◽

Moira K. Kapral ◽

Jiming Fang ◽

Ruth E. Hall

Keyword(s):

Ischemic Stroke ◽

Administrative Data ◽

Stroke Risk ◽

Billing Data ◽

Stroke Risk Factors ◽

Physician Billing ◽

Stroke Type ◽

Hospital Administrative ◽

Kappa Agreement ◽

Hospital Administrative Data

Background/Aims: The reliability of diagnostic coding of acute stroke and transient ischemic attack (TIA) in administrative data is uncertain. The purpose of this study is to determine the agreement between administrative data sources and chart audit for the identification of stroke type, stroke risk factors, and the use of hospital-based diagnostic procedures in patients with stroke or TIA. Methods: Medical charts for a population-based sample of patients (n = 14,508) with ischemic stroke, intracerebral hemorrhage (ICH), or TIA discharged from inpatient and emergency departments (ED) in Ontario, Canada, between April 1, 2012 and March 31, 2013, were audited by trained abstractors. Audited data were linked and compared with hospital administrative data and physician billing data. The positive predictive value (PPV) of hospital administrative data and kappa agreement for the reporting of stroke type were calculated. Kappa agreement was also determined for stroke risk factors and for select stroke-related procedures. Results: The PPV for stroke type in inpatient administrative data ranged from 89.5% (95% CI 88.0-91.0) for TIA, 91.9% (95% CI 90.2-93.5) for ICH, and 97.3% (95% CI 96.9-97.7) for ischemic stroke. For ED administrative data, PPV varied from 78.8% (95% CI 76.3-81.2) for ischemic, 86.3% (95% CI 76.8-95.7) for ICH, and 95.3% (95% CI 94.6-96.0) for TIA. The chance-corrected agreement between the audited and administrative data was good for atrial fibrillation (k = 0.60) and very good for diabetes (k = 0.86). Hospital administrative data combined with physician billing data more than doubled the observed agreement for carotid imaging (k = 0.65) and echocardiography (k = 0.66) compared to hospital administrative data alone. Conclusions: Inpatient and ED administrative data were found to be reliable in the reporting of the International Classification of Diagnosis, 10th revision, Canada (ICD-10-CA)-coded ischemic stroke, ICH and TIA, and for the recording of atrial fibrillation and diabetes. The combination of physician billing data with hospital administrative data greatly improved the capture of some diagnostic services provided to inpatients.

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Vibration of Long Stroke Type Marine Diesel Engine (1st report)

Journal of the Society of Naval Architects of Japan ◽

10.2534/jjasnaoe1968.1983.154_470 ◽

1983 ◽

Vol 1983 (154) ◽

pp. 470-476

Author(s):

Koji Kagawa ◽

Kazunobu Fujita ◽

Ou Kitamura

Keyword(s):

Diesel Engine ◽

Marine Diesel Engine ◽

Marine Diesel ◽

Stroke Type ◽

Long Stroke

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Smoking and Stroke in Appalachian Kentucky

Neurology and Neurobiology ◽

10.31487/j.nnb.2018.10.006 ◽

2018 ◽

pp. 1-4

Author(s):

Dignan Mark ◽

Kitzman Patrick ◽

S Gutti Subhash ◽

N Gutti Swathi ◽

...

Keyword(s):

Medical Records ◽

Case Series ◽

Eastern Region ◽

Retrospective Case ◽

Series Design ◽

Stroke Prevalence ◽

Appalachian Kentucky ◽

The Mean ◽

Stroke Type ◽

Stroke Belt

This project used a retrospective case series design to investigate factors associated with stroke in a rural area in Appalachian Kentucky. The south-eastern region of the U.S. is often referred to as the ‘stroke belt,’ and includes the Appalachian region of the state of Kentucky. Data were collected from medical records of patients from a neurology practice and regional hospital with a diagnosis of stroke from March 2012 through November 2015. Data were collected without personal identifiers and included demographic characteristics, stroke type, treatments received, and referrals for additional care including rehabilitation. Data from a total of 84 stroke cases diagnosed between March 2012 and November 2015 were included. Of the 84 cases, 46 (54.8%) were female and all but one was Caucasian. The distribution by race is consistent with the population of the region. The stroke cases ranged in age from 41 to 92 (M=66.3) and the age at stroke diagnosis ranged from 40 to 90 (M=65.7). Fourteen (16.7%) had evidence of a previous stroke at diagnosis. For smokers, the mean age at diagnosis was 62.7 for smokers while for non-smokers it was 67.5. The study reported smoking rates that were nearly three-times the national average, and the smokers in this study were found to have stroke onset approximately five-years earlier than non-smokers. The results from this case series support the need for further investigation on stroke prevalence and factors contributing to continued risk for stroke in Appalachia.

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