Background and Purpose-Sustained successful reperfusion is an important prognostic factor for good clinical outcome in acute ischemic stroke. We aimed to identify the prevalence, clinical impact, and predictors of early reocclusion after initially successful thrombectomies within a prospective cohort. Methods-A total of 711 stroke patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b/3) followed with magnetic resonance or computed tomographic angiography at 24 to 48 hours were included. Multivariable logistic regression analysis was used to evaluate associated factors and clinical impact. Results are displayed as adjusted odds ratio (aOR) and 95% CI. Improvement in accuracy of additional imaging findings on angiography control runs after the intervention was evaluated by area under the curve. Results-Early reocclusion was observed in 16 of 711 successfully reperfused patients (2.3%; 95% CI: 1.1-3.3; median delay: 20 hours). Suggestive predictors were higher platelets on admission (aOR, 1.01; 95% CI: 1.01-1.02), prestroke functional dependence (aOR, 7.12; 95% CI: 1.49-34.03), and stroke of undetermined or other specified pathogenesis in the TOAST classification (aOR, 7.19; 95% CI: 1.10-47.05 and aOR, 36.50; 95% CI: 4.47-298.11, respectively). When implementing residual embolic fragments or stenosis at the thrombectomy site into the logistic regression model, discrimination between patients with and without reocclusion improved significantly (area under the curve, 0.955 versus 0.854; P=0.023). Early reocclusion was an independent predictor of unfavorable outcome at 90 days (aOR for modified Rankin Scale ≤2, 0.13; 95% CI: 0.03-0.57). Conclusions-Early reocclusion within 48 hours after successful mechanical thrombectomy is rare but associated with poor outcome. Patients with high platelets on admission and residual embolic fragments or stenosis at the thrombectomy site are at high risk for reocclusion, which may be prevented or corrected after carefully re-evaluating the past angiographic run. (Stroke. 2018;49:00-00.
AIMS OF THE STUDY: Anaphylaxis is a medical emergency and requires prompt treatment to prevent life-threatening conditions. Epinephrine, considered as the first-line drug, is often not administered. We aimed first to analyse the use of epinephrine in patients with anaphylaxis in the emergency department of a university hospital and secondly to identify factors that influence the use of epinephrine. METHODS: We performed a retrospective analysis of all patients admitted with moderate or severe anaphylaxis to the emergency department between 1 January 2013 and 31 December 2018. Patient characteristics and treatment information were extracted from the electronic medical database of the emergency department. RESULTS: A total of 531 (0.2%) patients with moderate or severe anaphylaxis out of 260,485 patients admitted to the emergency department were included. Epinephrine was administered in 252 patients (47.3%). In a multivariate logistic regression, cardiovascular (Odds Ratio [OR] = 2.94, CI 1.96–4.46, p <0.001) and respiratory symptoms (OR = 3.14, CI 1.95–5.14, p<0.001) were associated with increased likelihood of epinephrine administration, in contrast to integumentary symptoms (OR = 0.98, CI 0.54–1.81, p = 0.961) and gastrointestinal symptoms (OR = 0.62, CI 0.39–1.00, p = 0.053). CONCLUSIONS: Less than half of the patients with moderate and severe anaphylaxis received epinephrine according to guidelines. In particular, gastrointestinal symptoms seem to be misrecognised as serious symptoms of anaphylaxis. Training of the emergency medical services and emergency department medical staff and further awareness are crucial to increase the administration rate of epinephrine in anaphylaxis.
Background Anaphylaxis is a medical emergency and requires prompt treatment to prevent life threatening conditions. Epinephrine considered as the first-line drug is often not administered. We aimed first to analyze the use of epinephrine in patients with anaphylaxis in the emergency department of a University Hospital and secondly to identify factors that influence the use of epinephrine. Methods We performed a retrospective analysis of all patients who were admitted with moderate or severe anaphylaxis to the emergency department between 1 January 2013 to 31 December 2018. Patient characteristics and treatment information were extracted from the electronic medical database or manually of the full emergency department discharge report. Results A total of 531 (0.2%) patients with moderate or severe anaphylaxis out of 260'485 patients admitted to the emergency department were included. Epinephrine was administered in 252 patients (47.3%). In a multivariate logistic regression cardiovascular (ORCARD = 2.94, CI 1.96–4.46, p < 0.001) and respiratory symptoms (ORRESP=3.14, CI 1.95–5.14, p < 0.001) were associated with increased likelihood of epinephrine administration, in contrast to integumentary symptoms (ORINTEGU = 0.98, CI 0.54–1.81, p = 0.961) and gastrointestinal symptoms (ORGAST=0.62, CI 0.39–1.00, p = 0.053). Conclusions Less than half of the patients with moderate and severe anaphylaxis received epinephrine according to guidelines. In particular, gastrointestinal symptoms seem to be misrecognized as serious symptoms of anaphylaxis. Training of the rescue service and emergency department medical staff and further awareness are crucial to increase the administration rate of epinephrine in anaphylaxis.
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