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Stroke and primary admitting physician

Christopher W Baugh, Carol L Clark, Jason W Wilson, Ian G Stiell, Abraham G Kocheril, Krista K Luck, Troy D Myers, Charles V Pollack, Steven K Roumpf, Gery F Tomassoni, James M Williams, Brian B Patel, Fred Wu, Jesse M Pines
Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States (US). Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Stacy A Trent, Michael A Johnson, Erica A Morse, Edward P Havranek, Jason S Haukoos
OBJECTIVES: Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence. METHODS: Design: Retrospective study at 3 hospitals in Colorado using standard medical record review...
December 29, 2017: American Journal of Emergency Medicine
Nicola Logallo, Vojtech Novotny, Jörg Assmus, Christopher E Kvistad, Lars Alteheld, Ole Morten Rønning, Bente Thommessen, Karl-Friedrich Amthor, Hege Ihle-Hansen, Martin Kurz, Håkon Tobro, Kamaljit Kaur, Magdalena Stankiewicz, Maria Carlsson, Åse Morsund, Titto Idicula, Anne Hege Aamodt, Christian Lund, Halvor Næss, Ulrike Waje-Andreassen, Lars Thomassen
BACKGROUND: Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis. METHODS: This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway...
October 2017: Lancet Neurology
Achary Umesh, Guru S Gowda, Channaveerachari Naveen Kumar, Dwarakanath Srinivas, Bharath Rose Dawn, Ragasudha Botta, Ravi Yadav, Suresh Bada Math
OBJECTIVES: A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of "unknown" patients...
April 2017: Annals of Indian Academy of Neurology
Kamilia S Funder, Lars S Rasmussen, Nicolai Lohse, Rasmus Hesselfeldt, Volkert Siersma, Jesper Gyllenborg, Sandra Wulffeld, Ole M Hendriksen, Freddy K Lippert, Jacob Steinmetz
BACKGROUND: Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit. METHODS: Prospective, observational study with 5.5 years of follow-up. We included patients admitted to the stroke unit the first three years after implementation of a helicopter emergency medical services (HEMS) from a geographical area covered by both the HEMS and the ground emergency medical services (GEMS)...
February 23, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
J David Cassidy, Eleanor Boyle, Pierre Côté, Sheilah Hogg-Johnson, Susan J Bondy, Scott Haldeman
BACKGROUND: Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke...
April 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Kimon Bekelis, Nancy J Marth, Kendrew Wong, Weiping Zhou, John D Birkmeyer, Jonathan Skinner
IMPORTANCE: Physicians often must decide whether to treat patients with acute stroke locally or refer them to a more distant Primary Stroke Center (PSC). There is little evidence on how much the increased risk of prolonged travel time offsets benefits of a specialized PSC care. OBJECTIVES: To examine the association of case fatality with receiving care in PSCs vs other hospitals for patients with stroke and to identify whether prolonged travel time offsets the effect of PSCs...
September 1, 2016: JAMA Internal Medicine
Benjamin D Bray, Geoffrey C Cloud, Martin A James, Harry Hemingway, Lizz Paley, Kevin Stewart, Pippa J Tyrrell, Charles D A Wolfe, Anthony G Rudd
BACKGROUND: Studies in many health systems have shown evidence of poorer quality health care for patients admitted on weekends or overnight than for those admitted during the week (the so-called weekend effect). We postulated that variation in quality was dependent on not only day, but also time, of admission, and aimed to describe the pattern and magnitude of variation in the quality of acute stroke care across the entire week. METHODS: We did this nationwide, registry-based, prospective cohort study using data from the Sentinel Stroke National Audit Programme...
July 9, 2016: Lancet
Kavelin Rumalla, Manoj K Mittal
BACKGROUND AND OBJECTIVE: Over half of all patients admitted with acute ischemic stroke (AIS) suffer gastrointestinal complications. Our goal was to determine the burden of gastrointestinal bleeding (GIB) in hospitalized patients with AIS using the largest, all-payer, inpatient database in the United States. METHODS: The Nationwide Inpatient Sample (2002-2011) was queried to identify all adult patients with a primary diagnosis of AIS with and without a secondary diagnosis of GIB...
July 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Peter A Kempster, Catriona A McLean, Thanh G Phan
Angiitis of the central nervous system (CNS) is difficult to diagnose but potentially fatal. When stroke occurs in a younger individual or is associated with multiple infarcts on imaging, clinicians must decide how far to pursue a possible diagnosis of vasculitis. The aim of this study is to establish the prevalence of primary and secondary cerebral angiitis among patients presenting with stroke. Hospital attendances over a 10year period were surveyed by searching for diagnostic codes and key words specific for cerebral vasculitis/angiitis...
May 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Dustin W Ballard, Anthony S Kim, Jie Huang, David K Park, Mamata V Kene, Uli K Chettipally, Hilary R Iskin, John Hsu, David R Vinson, Dustin G Mark, Mary E Reed
STUDY OBJECTIVE: Electronic health record systems with computerized physician order entry and condition-specific order sets are intended to standardize patient management and minimize errors of omission. However, the effect of these systems on disease-specific process measures and patient outcomes is not well established. We seek to evaluate the effect of computerized physician order entry electronic health record implementation on process measures and short-term health outcomes for patients hospitalized with acute ischemic stroke...
December 2015: Annals of Emergency Medicine
Frank Xavier Scheuermeyer, Martha Mackay, Jim Christenson, Eric Grafstein, Reza Pourvali, Claire Heslop, Jan MacPhee, John Ward, Brett Heilbron, Lorraine McGrath, Karin Humphries
OBJECTIVES: In non-emergency department (ED) settings, women with atrial fibrillation and flutter (AFF) have different presentations, treatments, and outcomes than men: they are older, less likely to be treated with rhythm control strategies or appropriate anticoagulation, and more likely to have strokes. This has not been investigated in ED patients. METHODS: Records from consecutive ED patients from January 1 to December 31, 2009, with electrocardiogram-proven AFF at two urban hospitals were collected...
September 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Hervé Quintard, Mathilde Severac, Claude Martin, Carole Ichai
INTRODUCTION: The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients...
August 2015: Anaesthesia, Critical Care & Pain Medicine
Michał Karliński, Marcin Gluszkiewicz, Anna Członkowska
INTRODUCTION: Time to treatment is the key factor in stroke care. Although the initial medical assessment is usually made by a non-neurologist or a paramedic, it should ensure correct identification of all acute cerebrovascular accidents (CVAs). Our aim was to evaluate the accuracy of the physician-made prehospital diagnosis of acute CVA in patients referred directly to the neurological emergency department (ED), and to identify conditions mimicking CVAs. MATERIAL AND METHODS: This observational study included consecutive patients referred to our neurological ED by emergency physicians with a suspicion of CVA (acute stroke, transient ischemic attack (TIA) or a syndrome-based diagnosis) during 12 months...
June 19, 2015: Archives of Medical Science: AMS
Hendrik J F Helmerhorst, Marie-José Roos-Blom, David J van Westerloo, Evert de Jonge
OBJECTIVE: Oxygen is vital during critical illness, but hyperoxia may harm patients. Our aim was to systematically evaluate the methodology and findings of cohort studies investigating the effects of hyperoxia in critically ill adults. DATA SOURCE: A meta-analysis and meta-regression analysis of cohort studies published between 2008 and 2015 was conducted. Electronic databases of MEDLINE, EMBASE, and Web of Science were systematically searched for the keywords hyperoxia and mortality or outcome...
July 2015: Critical Care Medicine
S Honarbakhsh, L A Wakefield, N Sekhri, A Archbold, M Dhinoja, R Weerackody, K Ranjadayalan
INTRODUCTION: Anticoagulation in atrial fibrillation (AF) is strongly recommended in view of the fivefold increased risk of stroke. Current guidelines do not specify the timing of anticoagulation in patients admitted with new onset AF. There is no data comparing the effectiveness of inpatient vs. outpatient initiation of anticoagulation. METHOD: This was a single center, retrospective, observational study including patients admitted with new onset AF during 2013 (ICD-10 I48)...
October 2014: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jitphapa Pongmoragot, Alejandro A Rabinstein, Yongchai Nilanont, Richard H Swartz, Limei Zhou, Gustavo Saposnik
BACKGROUND: Limited information is available on the frequency of pulmonary embolism (PE) in patients with an acute ischemic stroke (AIS). We evaluated clinical characteristics, predisposing factors, and outcomes in AIS patients with PE. METHODS AND RESULTS: We included all AIS patients admitted to participating institutions in the Registry of the Canadian Stroke Network. Clinically PE was documented by a physician and confirmed by computed tomography pulmonary angiography within 30 days of the stroke case index...
November 25, 2013: Journal of the American Heart Association
Josephine M E Gibson, Mike Bullock, Gary A Ford, Stephanie P Jones, Michael J Leathley, Joanna J McAdam, Tom Quinn, Caroline L Watkins
BACKGROUND: Altered consciousness is an important symptom of acute stroke but assessment may be challenging when cognitive or language deficits are present. Callers are routinely questioned about conscious level by emergency medical services (EMS) call handlers for any presenting problem. OBJECTIVE: This study aimed to identify and compare how patients' conscious level was questioned, described and interpreted by callers and call handlers during acute stroke calls...
May 2013: Emergency Medicine Journal: EMJ
Uri Netz, Zvi Perry, Anat Horev, Sol Mizrachi
AIM: A substantial portion of acute stroke cases occur in hospitalized patients. Some of these events take place in a ward that does not usually treat acute stroke patients. This paper hopes to enhance the awareness and management of acute stroke episodes in wards that are not used to treating such cases. METHODS: Using an example of an acute stroke patient in a general surgical ward, we discuss the tribulations of recognition and primary treatment of acute stroke within a hospital using the AHA guidelines and present recommendations for treating such cases...
April 2011: Harefuah
Daniel Geffner, Cristina Soriano, Teresa Pérez, Carlos Vilar, David Rodríguez
OBJECTIVES: To find out about stroke patients: who decides to seek medical help, where they go, how long it takes to contact the health system and to arrive at the ED. METHODS: Prospective study of patients admitted in our hospital for transient or established stroke. RESULTS: Among 388 stroke patients (mean NIHSS of 7.8 (±7.4), there were 37 intracerebral hemorrhage, 70 TIA, and 281 cerebral infarction. 39.2% arrived at the ED in less than 3h...
January 2012: Clinical Neurology and Neurosurgery
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