Consciousness Level and Off‐Hour Admission Affect Discharge Outcome of Acute Stroke Patients: A J‐ASPECT Study

Kamitani, Satoru; Nishimura, Kunihiro; Nakamura, Fumiaki; Kada, Akiko; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Miyamoto, Yoshihiro; Iwata, Mamoru; Suzuki, Akifumi; Ishikawa, Koichi; Kataoka, Hiroharu; Morita, Kenichi; Kobayashi, Yasuki; Iihara, Koji

doi:10.1161/jaha.114.001059

Cited by 27 publications

(21 citation statements)

References 32 publications

(74 reference statements)

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“…[2,12,29–34] However, the effect of weekend or off-hour admission on mortality has been negated after adjustment for stroke severity as assessed by using a stroke scale or a similar proxy, [4,9,10,28,35,36] as seen in the present study. The present analysis also found that the effect of brain surgery on mortality turned from harmful to null after adjustment for stroke severity.…”

Section: Discussionmentioning

confidence: 54%

“Weekend effect” on stroke mortality revisited

et al. 2016

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Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08–1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95–1.20).The “weekend effect” on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.

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Section: Discussionmentioning

confidence: 54%

“Weekend effect” on stroke mortality revisited

et al. 2016

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“…Using this database, we have previously reported the discharge outcomes of cerebrovascular disease patients in a nationwide retrospective analysis (the J-ASPECT study). 11–13) In this study, we collected and analyzed all the DPC data for patients treated in 370 core and branch hospitals from a total of 847 hospitals participating in the Japan Neurosurgical Society training program. Brain tumor patients are treated in neurosurgical hospitals in Japan, and this treatment includes CTX and RT.…”

Section: Introductionmentioning

confidence: 99%

Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor)

Yoshimoto

Kada

Kuga

et al. 2016

Neurol. Med. Chir.(Tokyo)

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We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21–50 patients compared to those treating 1–10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan.

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“…The inclusion of admission serum glucose might be the critical component which leads to a higher discrimination power of predicting the unfavorable outcome of ICH patients using ICH‐FOS score than the max‐ICH score. The level of consciousness was reported to be one of the most significant factors of poor outcome of ICH patients . The superior performance of Essen‐ICH score in recognizing unfavorable long‐term outcome of ICH patients might due to highlighting the importance of consciousness level.…”

Section: Discussionmentioning

confidence: 99%