Community Hospital-based Stroke Programs: North Carolina, Oregon, and New York. I: Goals, objectives, and data collection procedures.

853

522

on behalf of the German Stroke Data Bank CollaboratorsBackground and Purpose-Data on risk factors for etiologic subtypes of ischemic stroke are still scant. The aim of this study was to characterize stroke subtypes regarding risk factor profile, outcome, and current treatment strategies. Methods-We analyzed data from 5017 patients with acute ischemic stroke (42.4% women, aged 65.9Ϯ14.1 years) who were enrolled in a large multicenter hospital-based stroke data bank. Standardized data assessment and stroke subtype classification were used by all centers. Results-Sex and age distribution, major risk factors and comorbidities, recurrent stroke, treatment strategies, and outcome were all unevenly distributed among stroke subtypes (PϽ0.001, respectively). Cardioembolism, the most frequent etiology of stroke (25.6%), was particularly common in the elderly (those aged Ͼ70 years) and associated with an adverse outcome, a low rate of early stroke recurrence, and frequent use of thrombolytic therapy and intravenous anticoagulation. Large-artery atherosclerosis (20.9%), the most common cause of stroke in middle-aged patients (those aged 45 to 70 years), showed the highest male preponderance, highest rate of early stroke recurrence, and highest prevalence of previous transient ischemic attack, current smoking, and daily alcohol consumption among all subtypes. The highest prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and obesity was found in small-vessel disease (20.5%), which, in turn, was associated with the lowest stroke severity and mortality. Conclusions-Our results foster the concept of ischemic stroke as a polyetiologic disease with marked differences between subtypes regarding risk factors and outcome. Therefore, studies involving risk factors of ischemic stroke should differentiate between etiologic stroke subtypes. (Stroke. 2001;32:2559-2566.)

Section: Discussionsupporting

confidence: 87%

Risk Factors, Outcome, and Treatment in Subtypes of Ischemic Stroke: The German Stroke Data Bank

Grau¹,

Weimar²,

Buggle³

et al. 2001

853

522

“…In the absence of brain neuroimaging or necropsy examination, a diagnosis of probable ICH was made in the presence of clinical manifestations reflecting increased intracranial pressure such as headache and vomiting, decreased alertness or coma, and gradual progression to death within 24 hours of onset. 11,12 Secondary ICHs were diagnosed in the presence of ruptured aneurysms, arteriovenous malformations, tumors, venous thrombosis, trauma, anticoagulation, or other known causes of ICHs. Patients who could not be categorized as ischemic, hemorrhagic, or due to subarachnoid hemorrhage because of the absence of adequate clinical signs or symptoms, and confirmatory investigations were included among those with ill-defined or unclassified cerebrovascular events (International Classification of Diseases, 9th Revision codes 436 to 437).…”

Section: Definitionsmentioning

confidence: 99%

Incidence and 10-Year Survival of Intracerebral Hemorrhage in a Population-Based Registry

Sacco

Marini²,

Toni³

et al. 2009

477

280

Background and Purpose-The purpose of this study was to evaluate the incidence and prognosis of intracerebral hemorrhage. Methods-We analyzed data referring to our prospective population-based registry, including patients with a first-ever stroke followed up to 10 years. Results-In a 5-year period, we included 549 patients (247 men and 302 women; mean ageϮSD, 73.6Ϯ12.5 years) with an intracerebral hemorrhage. The crude annual incidence rate was 36.9 per 100 000 (95% CI, 33.8 to 40.0), 32.9 per 100 000 when standardized to the 2006 European population, and 15.9 per 100 000 when standardized to the world population. The case-fatality rate was 34.6% (95% CI, 30.6 to 38.6) at 7 days; it increased to 50.3% (95% CI, 46.1 to 54.5) at 30 days and to 59.0% (95% CI, 54.9 to 63.1) at 1 year. Diabetes mellitus and posterior fossa hemorrhage were associated with an increased risk of 7-and 30-day mortality, whereas older age was associated with an increased risk of 30-day mortality only. At the Kaplan-Meier analysis, the 10-year survival rate was 24.1% (95% CI, 20.1 to 28.1). Conclusions-Intracerebral hemorrhage is characterized by a severe prognosis, mostly in the short term. Because of the high proportion of fatal events that occurs early after the stroke, it is mandatory to identify and apply specific therapeutic strategies for patients with intracerebral hemorrhage.

“…The risk factors were hypertension, cardiac disease, diabetes mellitus, previous TIA, and previous stroke; standard criteria were used to define hypertension, cardiac disease, and diabetes mellitus. 6 The diagnostic tests included computed tomography of the brain (CT), lumbar puncture, invasive cerebral angiography, radionuclide brain scanning, electrocardiography (ECG), and electroencephalography (EEG). As a measure of severity, level of consciousness at admission was scored for all patients as alert, disoriented/lethargic, or stuporous/comatose.…”

mentioning

confidence: 99%

Community hospital-based stroke programs in North Carolina, Oregon, and New York. IV. Stroke diagnosis and its relation to demographics, risk factors, and clinical status after stroke.

Coull

Brockschmidt

Howard

et al. 1990

Self Cite

The use of diagnostic tests, the accuracy of stroke type diagnosis, and their relationship to outcome are important from the standpoint of patient management and health care costs. To address this issue, we examined the differences between stroke types in terms of demographics, risk factors, diagnostic tests, and clinical outcome in the 4,129 patients who comprise the Community Hospital-Based Stroke Program. Previous transient ischemic attacks were equally frequent among patients with embolic and those with thrombotic stroke. For all stroke types, previous stroke was as frequent as previous transient ischemic attacks. Hypertension and cardiac disease were the most common risk factors, but 10% of all stroke patients had no recognized risk factors. Intracerebrai hemorrhage was most often associated with death (45%). There was a strong direct relation between in-hospital mortality and a decreased level of consciousness at admission. Overall, 30% of patients did not receive a specific stroke type diagnosis; these patients were elderly, usually nonwhite, and often had an altered level of consciousness at admission but had a risk factor profile similar to that of patients who received a specific stroke type diagnosis. In summary, our findings suggest the continued need for physician education about and refinement of stroke type diagnosis. (Stroke 1990^1:867-873)