Dataset Information

Safety of thrombolysis in stroke mimics: an observational cohort study from an urban teaching hospital in Sweden.

ABSTRACT: OBJECTIVES:Acute stroke management has changed dramatically over the recent years, where a timely assessment is driven by the expanding treatment options of acute ischaemic stroke. This increases the risk in treating non-stroke patients (stroke mimics) with a possibly hazardous intravenous thrombolysis treatment (IVT). SETTING:Patients of the thrombolysis registry of Södersjukhuset AB, a secondary health centre in Stockholm, were retrospectively studied to determine complications and outcome after IVT in strokes and stroke mimics. PARTICIPANTS:Consecutively, 674 recruited patients from 1 January 2008 to 1 December 2013 were analysed regarding demographics and outcome at 3 months after onset of symptoms. RESULTS:Ischaemic stroke was confirmed in 625 patients (93%), and 48 patients (7%) were stroke mimics. Patients with strokes were older than stroke mimics 72 (IQR: 64-81) vs 54 years (IQR 40-67), p<0.0001. Antihypertensive and antithrombotic treatment were more common in patients with stroke (p<0.0001 and p=0.006, respectively). National Institute of Health Stroke Scale did not differ at time of presentation. Excellent outcome defined as modified Rankin Scale score 0-1, at 3 months, was less common in stroke than in stroke mimics (50% vs 87.5%, p<0.0001). No stroke mimic had a symptomatic intracerebral haemorrhage. Age of less than 40 years may be a predictor for a patient to be a stroke mimic (OR: 8.7, 95% CI: 3.2 to 24.0, p<0.0001). CONCLUSIONS:Stroke mimics receiving IVT had a more favourable outcome compared with patients with stroke, and showed no haemorrhagic complications. Age below 40 years may be a predictor for stroke mimics.

SUBMITTER: Kostulas N

PROVIDER: S-EPMC5665231 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Safety of thrombolysis in stroke mimics: an observational cohort study from an urban teaching hospital in Sweden.

Kostulas Nikolaos N Larsson Martin M Kall Tor-Bjorn TB von Euler Mia M Nathanson David D

BMJ open 20171030 10

<h4>Objectives</h4>Acute stroke management has changed dramatically over the recent years, where a timely assessment is driven by the expanding treatment options of acute ischaemic stroke. This increases the risk in treating non-stroke patients (stroke mimics) with a possibly hazardous intravenous thrombolysis treatment (IVT).<h4>Setting</h4>Patients of the thrombolysis registry of Södersjukhuset AB, a secondary health centre in Stockholm, were retrospectively studied to determine complications ...[more]

PMID: 29084788

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Project description:ImportanceStroke is a major cause of morbidity and mortality. Timely administration of intravenous thrombolysis (IVT) is essential for improving outcomes for patients with acute ischemic stroke. Significant disparities exist in IVT administration based on socioeconomic and racial and ethnic backgrounds. Understanding how hospital-level segregation is associated with stroke treatment outcomes is crucial for addressing these disparities.ObjectiveTo investigate the association between hospital segregation, using the Index of Concentration at the Extremes (ICE), and IVT administration rates among patients with stroke.Design, setting, and participantsThis retrospective cohort study used US hospital data from the 2016-2020 National Inpatient Sample database. Using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes, patients admitted to hospitals with acute ischemic stroke were included. Statistical analysis was performed from March through July 2024.ExposureHospital segregation measured by the ICE, quantifying socioeconomic and racial and ethnic extremes within hospitals. ICE values range from -1 (predominantly Black and socioeconomically disadvantaged) to 1 (predominantly White and socioeconomically advantaged). Hospitals were categorized into ICE quintiles, with the first quintile representing the most disadvantaged hospitals, the third quintile representing a balanced patient mix, and the fifth quintile representing the most privileged hospitals.Main outcomes and measuresThe primary outcome was IVT administration rates. Secondary outcomes included racial and ethnic disparities in IVT administration across ICE quintiles.ResultsAmong 2 494 945 patients with stroke, the mean (SD) age was 70.1 (14.0) years, 50.2% were male, 0.5% were American Indian, 3.1% were Asian or Pacific Islander, 17.4% were Black, 8.2% were Hispanic, 68.2% were White, and 2.6% were other race or ethnicity. Of these patients, 65.4% were treated at hospitals in the third ICE quintile, while 1.2% of patients were treated at hospitals in the first ICE quintile. Patients at hospitals in the fourth and fifth ICE quintiles were significantly more likely to receive IVT (fourth quintile: adjusted odds ratio [AOR], 1.32 [95% CI, 1.26-1.38]; fifth quintile: AOR, 1.27 [95% CI, 1.21-1.34]) compared with those in the first quintile. Racial and ethnic disparities in IVT administration were most pronounced in the first ICE quintile, where Black patients were 32% less likely than White patients to receive IVT (AOR, 0.68 [95% CI, 0.58-0.79]). This disparity decreased but persisted in higher quintiles.Conclusions and relevanceIn this study of hospital segregation and IVT administration rates, segregation was associated with lower likelihood of IVT administration for patients at hospitals serving predominantly Black and socioeconomically disadvantaged communities. Socioeconomic improvements were associated with reduced, but not eliminated, racial and ethnic disparities in stroke treatment. Addressing structural racism and segregation is crucial for equitable access to stroke care.

Project description:ImportanceThe Hospital-Acquired Condition Reduction Program (HACRP) evaluates acute care hospitals on the occurrence of patient safety events and health care-associated infections. Since its implementation, several studies have raised concerns about the overpenalization of teaching and safety-net hospitals, and although several changes in the program's methodology have been applied in the last few years, whether these changes reversed the overpenalization of teaching and safety-net hospitals is unknown.ObjectiveTo determine hospital characteristics associated with HACRP penalization and penalization reversal.Design, setting, and participantsThis retrospective cross-sectional study assessed data from 3117 acute care hospitals participating in the HACRP. The HACRP penalization and hospital characteristics were obtained from Hospital Compare (2020 and 2021), the Inpatient Prospective Payment System impact file (2020), and the American Hospital Association annual survey (2018).ExposuresHospital characteristics, including safety-net status and teaching intensity (no teaching and very minor, minor, major, and very major teaching levels).Main outcomes and measuresThe primary outcome was HACRP penalization (ie, hospitals that fell within the worst quartile of the program's performance). Multivariable models initially included all covariates, and then backward stepwise variable selection was used.ResultsOf 3117 hospitals that participated in HACRP in 2020, 779 (25.0%) were safety-net hospitals and 1090 (35.0%) were teaching institutions. In total, 771 hospitals (24.7%) were penalized. The HACRP penalization was associated with safety-net status (odds ratio [OR], 1.41 [95% CI, 1.16-1.71]) and very major teaching intensity (OR, 1.94 [95% CI, 1.15-3.28]). In addition, non-federal government hospitals were more likely to be penalized than for-profit hospitals (OR, 1.62 [95% CI, 1.23-2.14]), as were level I trauma centers (OR, 2.05 [95% CI, 1.43-2.96]) and hospitals located in the New England region (OR, 1.65 [95% CI, 1.12-2.43]). Safety-net hospitals with major teaching levels were twice as likely to be penalized as non-safety-net nonteaching hospitals (OR, 2.15 [95% CI, 1.14-4.03]). Furthermore, safety-net hospitals penalized in 2020 were less likely (OR, 0.64 [95% CI, 0.43-0.96]) to revert their HACRP penalization status in 2021.Conclusions and relevanceFindings from this cross-sectional study indicated that teaching and safety-net hospital status continued to be associated with overpenalization in the HACRP despite recent changes in its methodology. Most of these hospitals were also less likely to revert their penalization status. A reevaluation of the program methodology is needed to avoid depleting resources of hospitals caring for underserved populations.

Project description:BackgroundDeaths due to overdose from illicit drugs have risen in Canada, despite various community-led harm reduction programs. There have been limited pharmacist-led inpatient initiatives aimed at reducing opioid harm. The authors' group recently developed and implemented the Medication and Risk Factor Review, Optimize, Refer at Risk Patients, Educate and Plan (MORE) tool, a systematic checklist designed to help pharmacists follow and enhance the safety of in-hospital opioid prescribing.ObjectivesTo evaluate the impact of a pharmacist-led opioid stewardship program utilizing the MORE tool in the care of patients at one tertiary teaching hospital.MethodsThis study involved a review of health care records for patients admitted to general surgery and internal medicine clinical teaching units at a tertiary hospital between September 10 and December 31, 2018, for whom opioids were prescribed during the hospital stay. A descriptive data analysis was performed for patients who underwent assessment with the MORE tool.ResultsOf the 210 patients who met the initial eligibility criteria, including in-hospital opioid therapy for at least 3 days, 50 were assessed by a pharmacist using the MORE tool. For 40 (80%) of these patients, the pharmacist recommended an intervention, and 35 (87.5%) of these interventions were accepted by the prescriber. Among all 50 patients, the most common pharmacist interventions were adding or optimizing non-opioid pain medications (23 patients [46%]), decreasing opioid dose or frequency (15 patients [30%]), and adding a bowel regimen (9 patients [18%]).ConclusionsMost patients who underwent assessment by a pharmacist had risk factors for adverse events from opioid prescriptions and/or suboptimal orders and drug combinations. The MORE tool provided a guided approach for pharmacists to make targeted interventions aimed at improving opioid safety. A dedicated opioid stewardship pharmacist might be able to provide additional benefit.

Dataset Information

Safety of thrombolysis in stroke mimics: an observational cohort study from an urban teaching hospital in Sweden.

Publications

Safety of thrombolysis in stroke mimics: an observational cohort study from an urban teaching hospital in Sweden.

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