In-Hospital Acute Ischemic Stroke is Associated with Worse Outcome: Experience of a Single Center in Santiago Chile

Brunser, Alejandro M.; Navia, Victor; Araneda, Patricia; Mazzon, Enrico; Muñoz, Paula; Cavada, Gabriel; Olavarría, Verónica V.; Lavados, Pablo M.

doi:10.1016/j.jstrokecerebrovasdis.2021.105894

Cited by 5 publications

(9 citation statements)

References 14 publications

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“…Several studies have indicated delays in recognition and assessment of patients with HOS [ 2 , 8 , 11 ], whilst others found no differences [ 4 ]. Our observation of a lower proportion of HOS receiving neuroimaging within 12 h was consistent with previous reports [ 7 , 8 ]; and such patients were less likely to have a neurological examination [ 5 ]. Furthermore, evidence of a lower proportion of HOS patients undergoing swallow screening within the Royal College of Physicians target of 4 h of diagnosis is detrimental, as is the higher proportion with delayed swallow screening beyond 72 h. Delayed swallow screening is associated with poor outcomes in acute stroke patients [ 22 ], as early swallow screening is vital to allow correct decisions on nutritional support to be made, thus leading to better stroke recovery [ 30 ].…”

Section: Discussionsupporting

confidence: 93%

“…Patients with HOS were older and proportionally more had underlying health conditions, also been observed in previous studies, including CHF [ 6 , 7 ] and AF [ 3 , 6 ]. Arterial disease, which is the underlying aetiology of many cardiovascular diseases, has been more commonly identified in patients with HOS [ 4 ].…”

Section: Discussionsupporting

confidence: 70%

“…Patients with HOS were older and proportionally more had underlying health conditions, also been observed in previous studies, including CHF [6,7] and AF [3,6]. Arterial Fig.…”

Section: Age and Co-morbiditiessupporting

confidence: 68%

“…The proportions of hypertension and diabetes were present equally in both groups in this study, consistent with findings from previous studies [ 4 ]. In addition, a higher proportion of serious conditions such as active malignancies amongst patients with HOS has also been demonstrated [ 7 , 27 ], which is likely to be due to cancer-associated hypercoagulation and migratory thromboembolism [ 28 ]. The observation of high proportions of patients undergoing surgical intervention with HOS [ 2 , 4 ] may possibly be due to temporary discontinuation of antiplatelets or anticoagulants, especially those with a history of AF [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The numbers of patients with HOS per annum have been estimated to be 35,000-75,000 in the USA [2] and 4000 in England and Wales [1]. Compared to patients with COS, those with HOS remain at greater risk of poor outcomes including post-stroke disability [4][5][6], mortality [5][6][7], prolonged length of stay (LOS) in hospital [8], and less likely to be discharged home [5,6]. Despite its worse outcomes, HOS has often been overlooked in major reports [1,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of characteristics, management and outcomes in hospital-onset and community-onset stroke: a multi-centre registry-based cohort study of acute stroke

et al. 2022

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Objective Hospital-onset stroke (HOS) is associated with poorer outcomes than community-onset stroke (COS). Previous studies have variably documented patient characteristics and outcome measures; here, we compare in detail characteristics, management and outcomes of HOS and COS. Methods A total of 1656 men (mean age ± SD = 73.1 years ± 13.2) and 1653 women (79.3 years ± 13.0), with data prospectively collected (2014–2016) from the Sentinel Stroke National Audit Programme, were admitted with acute stroke in four UK hyperacute stroke units (HASU). Associations between variables were examined by chi-squared tests and multivariable logistic regression (COS as reference). Results There were 272 HOS and 3037 COS patients with mean ages of 80.2 years ± 12.5 and 76.4 years ± SD13.5 and equal sex distribution. Compared to COS, HOS had higher proportions ≥ 80 years (64.0% vs 46.4%), congestive heart failure (16.9% vs 4.9%), atrial fibrillation (25.0% vs 19.7%) and pre-stroke disability (9.6% vs 5.1%), and similar history of stroke, hypertension, diabetes, stroke type and severity of stroke. After age, sex and co-morbidities adjustments, HOS had greater risk of pneumonia: OR (95%CI) = 1.9 (1.3–2.6); malnutrition: OR = 2.2 (1.7–2.9); immediate thrombolysis complications: OR = 5.3 (1.5–18.2); length of stay on HASU > 3 weeks: OR = 2.5 (1.8–3.4); post-stroke disability: OR = 1.8 (1.4–2.4); and in-hospital mortality: OR = 1.8 (1.2–2.4), as well as greater support at discharge including palliative care: OR = 1.9 (1.3–2.8); nursing care: OR = 2.0 (1.3–4.0), help for daily living activities: OR = 1.6 (1.1–2.2); and joint-care planning: OR = 1.5 (1.1–1.9). Conclusions This detailed analysis of underlying differences in subject characteristics between patients with HOS or COS and adverse consequences provides further insights into understanding poorer outcomes associated with HOS.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 70%

“…Patients with HOS were older and proportionally more had underlying health conditions, also been observed in previous studies, including CHF [6,7] and AF [3,6]. Arterial Fig.…”

Section: Age and Co-morbiditiessupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of characteristics, management and outcomes in hospital-onset and community-onset stroke: a multi-centre registry-based cohort study of acute stroke

et al. 2022

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Pre-hospital benzodiazepines associated with improved outcomes in out-of-hospital status epilepticus: A 10-year retrospective cohort study

2022

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Oral presentation assessment and image reading behaviour on brain computed tomography reading in novice clinical learners: an eye-tracking study

et al. 2022

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Background To study whether oral presentation (OP) assessment could reflect the novice learners’ interpretation skills and reading behaviour on brain computed tomography (CT) reading. Methods Eighty fifth-year medical students were recruited, received a 2-hour interactive workshop on how to read brain CT, and were assigned to read two brain CT images before and after instruction. We evaluated their image reading behaviour in terms of overall OP post-test rating, the lesion identification, and competency in systematic image reading after instruction. Students’ reading behaviour in searching for the target lesions were recorded by the eye-tracking technique and were used to validate the accuracy of lesion reports. Statistical analyses, including lag sequential analysis (LSA), linear mixed models, and transition entropy (TE) were conducted to reveal temporal relations and spatial complexity of systematic image reading from the eye movement perspective. Results The overall OP ratings [pre-test vs. post-test: 0 vs. 1 in case 1, 0 vs. 1 in case 2, p < 0.001] improved after instruction. Both the scores of systematic OP ratings [0 vs.1 in both cases, p < 0.001] and eye-tracking studies (Case 1: 3.42 ± 0.62 and 3.67 ± 0.37 in TE, p = 0.001; Case 2: 3.42 ± 0.76 and 3.75 ± 0.37 in TE, p = 0.002) showed that the image reading behaviour changed before and after instruction. The results of linear mixed models suggested a significant interaction between instruction and area of interests for case 1 (p < 0.001) and case 2 (p = 0.004). Visual attention to the target lesions in the case 1 assessed by dwell time were 506.50 ± 509.06 and 374.38 ± 464.68 milliseconds before and after instruction (p = 0.02). However, the dwell times in the case 2, the fixation counts and the frequencies of accurate lesion diagnoses in both cases did not change after instruction. Conclusion Our results showed OP performance may change concurrently with the medical students’ reading behaviour on brain CT after a structured instruction.

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In-Hospital Acute Ischemic Stroke is Associated with Worse Outcome: Experience of a Single Center in Santiago Chile

Cited by 5 publications

References 14 publications

Comparison of characteristics, management and outcomes in hospital-onset and community-onset stroke: a multi-centre registry-based cohort study of acute stroke

Comparison of characteristics, management and outcomes in hospital-onset and community-onset stroke: a multi-centre registry-based cohort study of acute stroke

Pre-hospital benzodiazepines associated with improved outcomes in out-of-hospital status epilepticus: A 10-year retrospective cohort study

Oral presentation assessment and image reading behaviour on brain computed tomography reading in novice clinical learners: an eye-tracking study

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