An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings

Irisawa, Taro; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Sakai, Tomohiko; Tanigawa-Sugihara, Kayo; Hayashida, Sumito; Nishiuchi, Tatsuya; Shiozaki, Tadahiko; Tasaki, Osamu; Kawamura, Takashi; Hiraide, Atsushi; Shimazu, Takeshi

doi:10.1186/1471-227x-13-24

Cited by 17 publications

(21 citation statements)

References 14 publications

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“…impaired consciousness showed that stroke diagnoses increased with the presence of elevated prehospital BP, particularly .160 mm Hg, relative to patients with other diagnoses. 19 These data are consistent with our observation that elevated prehospital BP is higher in patients with acute stroke relative to other diagnoses.…”

Section: Relationship Of Prehospital Bp and Sbp On Ed Arrivalsupporting

confidence: 83%

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

et al. 2016

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Objective: To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic).Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted. Hospital charts and neuroimaging were utilized to determine the final diagnosis (ischemic stroke, TIA, ICH, or stroke mimic). Conclusions: Prehospital SBP is higher in acute stroke relative to stroke mimics and highest in ICH. Given the stability of BP between initial EMS and ED measurements, it may be reasonable to test the feasibility and safety of prehospital antihypertensive therapy in patients with suspected acute stroke. Elevated hospital admission blood pressure (BP) in patients with acute stroke is common 1 and is associated with poor outcomes. [2][3][4][5] There is limited randomized clinical trial evidence that acute BP reduction improves outcomes after intracerebral hemorrhage (ICH). Results6 One of the hypothesized reasons for the modest treatment effect is that hematoma enlargement and clinical deterioration have already begun by the time antihypertensive therapy is administered. It has been suggested that initiation of BP reduction in the prehospital setting may improve the efficacy of this approach. Recent pilot studies have assessed the feasibility of a prehospital BP-lowering strategy in patients with acute stroke symptoms using topical glyceryl trinitrate 8 and sublingual lisinopril. 9 At this point, however, the natural history of BP in the prehospital setting in patients with acute stroke symptoms is poorly understood. In contrast, the course of BP after hospital admission has been well described. Pressures are highest at admission, begin to spontaneously decline almost immediately, 10 and this trend continues for several days.

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Section: Relationship Of Prehospital Bp and Sbp On Ed Arrivalsupporting

confidence: 83%

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

et al. 2016

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“…For decades, the JCS has been used in various emergency settings to assess patients’ consciousness levels in Japan [10, 11, 20–23]. Shigematsu et al emphasized several advantages of the JCS, including its simplicity, reliability, and applicability [10].…”

Section: Discussionmentioning

confidence: 99%

Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients

et al. 2019

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BackgroundThe Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients.MethodsUsing the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation.ResultsA total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871–0.878) and 0.878 (0.874–0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12–2.45), 4.81 (4.42–5.24), and 27.88 (25.74–30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category.ConclusionsJCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

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“…The EMS system is basically the same as that used in other areas of Japan, as previously described . After the introduction of the ORION system, emergency dispatchers in Osaka Prefecture did not make telephone calls to hospitals for patient acceptance; rather, EMS personnel at the scene selected appropriate hospitals and transported patients to the hospitals including critical care centers during the study period.…”

Section: Methodsmentioning

confidence: 99%

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

Okamoto

Katayama

Kitamura

et al. 2018

Acute Medicine & Surgery

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AimTo describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in‐hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan.MethodsThe Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on‐scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data.ResultsFrom January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system.ConclusionUsing the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.

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An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings

Cited by 17 publications

References 14 publications

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients

Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population‐based registry of emergency patients with both ambulance and in‐hospital records

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