Mortality and functional outcomes of endovascular stroke therapy in the United States

2020 ◽  
Author(s):  
Fahad Alqahtani ◽  
Mohammed Osman ◽  
Alyssa Hartsell Harris ◽  
Samuel F. Hohmann ◽  
Mohamad Alkhouli
Keyword(s):  
United States ◽  
Functional Outcomes ◽  
The United States ◽  
Stroke Therapy ◽  
Endovascular Stroke Therapy

Survey of Interventional Radiologists providing Endovascular Stroke Therapy in the United States

2021 ◽  
Author(s):  
Martin G. Radvany ◽  
David Sacks ◽  
Aliza Brown ◽  
Joan C. Wojak ◽  
Joseph J. Gemmete ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Stroke Therapy ◽  
Endovascular Stroke Therapy

Abstract TP160: What Matters Most? Predictors of Poststroke Functional Outcomes From Inpatient Rehabilitation Facilities Across the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
James J García ◽  
Karlita L Warren ◽  
Fengmei Gong ◽  
Honggang Wang
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Sociodemographic Factors ◽  
Administrative Database ◽  
Cross Sectional ◽  
Rehabilitation Facilities ◽  
Stroke Type

Introduction: Stroke is one of the leading cause of disability and death in the United States (Benjamin et al., 2018). Inpatient rehabilitation is the gold standard treatment for post-acute care (Weinstein et al., 2016). Data indicate a discharge to inpatient rehabilitation facilities (IRFs) following the acute stroke phase has increased (Buntin, Colla, & Escarce, 2009). The inpatient milieu provides a unique opportunity to examine predictors of functional outcomes using a captive sample. Thus, the current study aim is to identify factors associated with poststroke functional outcomes throughout inpatient rehabilitation. Method: This is a cross-sectional and retrospective analysis of data extracted from an administrative database during years 2005-2016 from 244,286 stroke patients across 30% of IRFs in the U.S. Inclusion criteria were patients at or above the age 18 with stroke as an admitting diagnosis using ICD 9/10 codes 430-438/I60-I69. Dependent variables were: admission Total FIM, Total FIM efficiency, discharge Total FIM, and length of stay (LOS). Results: Using separate regression analyses, marital status, admit year, type of admission, race/ethnicity, insurance type, sex, age, number of complications, number of comorbidities, and stroke type, emerged as significant predictors of functional outcomes throughout inpatient rehabilitation. Moreover, those with greater comorbidities and complications were associated with lower admission FIM total score, less total FIM efficiency, lower discharge FIM total score, and a longer LOS. Compared to NHWs, racial/ethnic people were associated with lower FIM scores throughout inpatient rehabilitation and a longer length of stay. Discussion: In this robust national dataset, data indicate clinical and sociodemographic factors are significantly associated with poststroke functional outcomes throughout inpatient rehabilitation. Implications are discussed within a framework of social determinants of health.

Emergency Trauma Providers as Equal Partners: From “Proof of Concept” to “Outcome Parity”

2019 ◽  
Vol 85 (9) ◽  
pp. 961-964
Author(s):  
Kathryn C. Kelley ◽  
Alex Alers ◽  
Charles Bendas ◽  
Peter G. Thomas ◽  
James Cipolla ◽  
...  
Keyword(s):  
United States ◽  
Injury Severity Score ◽  
Severity Score ◽  
Functional Outcomes ◽  
Injury Severity ◽  
The United States ◽  
Patient Age ◽  
Lengths Of Stay ◽  
Patient Âgé ◽  
Surgical Critical Care

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board–exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CTimaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs’ performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.

scholarly journals Editorial: Workforce needs for endovascular acute ischemic stroke therapy: myth or reality?

2014 ◽  
Vol 36 (1) ◽  
pp. E8 ◽  
Author(s):  
Harry Cloft
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Stroke Therapy ◽  
Adequate Supply ◽  
Intraarterial Therapy ◽  
Workforce Needs ◽  
Future Demand

The acute ischemic strokes amenable to intraarterial therapy probably number no more than 20,000 per year in the United States. The future demand for intraarterial reperfusion techniques may change, but the fraction of patients who require intraarterial thrombolysis is currently rather low, and the number of neurointerventionists is adequate. Each hospital caring for patients with acute stroke will need to determine its own demand for intraarterial therapy and employ an adequate supply of qualified neurointerventionists available to meet demand. Comprehensive stroke centers are now being designated and hopefully will foster a rational, regionalized approach to the delivery of endovascular therapies for stroke.

scholarly journals Mexican American Immigrants Demonstrate Better Functional Stroke Outcomes Compared With Mexican American Nonimmigrants

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3129-3132 ◽  
Author(s):  
Cecilia N. Hollenhorst ◽  
River Gibbs ◽  
Sehee Kim ◽  
Charles Agyemang ◽  
Lynda Lisabeth ◽  
...  
Keyword(s):  
United States ◽  
Activities Of Daily Living ◽  
Mexican Americans ◽  
Functional Outcomes ◽  
Daily Living ◽  
Mexican American ◽  
The United States ◽  
Mean Difference ◽  
Cognitive Outcomes ◽  
Neurological Outcomes

Background and Purpose: We analyzed differences in 90-day poststroke outcomes between Mexican Americans born in the United States (nonimmigrant) compared with those born outside the United States (immigrant). Methods: We performed a retrospective analysis of prospective data from the population-based Brain Attack Surveillance in Corpus Christi project. We identified stroke cases from 2008 to 2016 and quantified functional, cognitive, and neurological outcomes. Associations between outcome scores and immigration status were analyzed using weighted linear regression models. Results: Eighty-three Mexican American stroke cases (n=935) were immigrants, and 852 stroke cases were nonimmigrants. Average length of stay in the United States for immigrants was 47 years. Immigrants were older (69 versus 66 years), more likely men (60% versus 49%), had less education on average, and were more likely to have atrial fibrillation compared with nonimmigrants. No differences in other comorbidities existed between groups. After adjustment for confounders, immigrants had better functional outcomes (activities of daily living/instrumental activities of daily living; mean difference, −0.22; P =0.02; 1–4, higher scores worse) and no difference in neurological outcomes (log-National Institutes of Health Stroke Scale; mean difference, −0.15; P =0.15; 0–44, higher scores worse) or cognitive outcomes (3 Mini-Mental State Examination; mean difference, −0.79; P =0.64; 0–100, lower scores worse). Conclusions: Long-term Mexican American immigrants in this community display better stroke functional outcomes than nonimmigrant Mexican Americans and comparable neurological and cognitive outcomes.

scholarly journals Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy

Stroke ◽  
2021 ◽  
Author(s):  
Pedro Castro ◽  
Francisca Ferreira ◽  
Cindy K. Nguyen ◽  
Seyedmehdi Payabvash ◽  
Can Ozan Tan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spectral Analysis ◽  
High Frequency ◽  
Functional Outcomes ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Rapid Assessment ◽  
Neurological Recovery ◽  
Stroke Therapy ◽  
Endovascular Stroke Therapy

Background and Purpose: High blood pressure (BP) variability after endovascular stroke therapy is associated with poor outcome. Conventional BP variability measures require long recordings, limiting their utility as a risk assessment tool to guide clinical decision-making. Here, we performed rapid assessment of BP variability by spectral analysis and evaluated its association with early clinical improvement and long-term functional outcomes. Methods: We conducted a prospective study of 146 patients with anterior circulation ischemic stroke who underwent successful endovascular stroke therapy. Spectral analysis of 5-minute recordings of beat-to-beat BP was used to quantify BP variability. Outcomes included initial clinical response and modified Rankin Scale at 90 days. Results: Increased BP variability at high frequencies was independently associated with poor functional outcome at 90 days (adjusted odds ratio [aOR], 1.85 [95% CI, 1.07–3.25], P =0.03; low-/high-frequency ratio aOR, 0.67 [95% CI, 0.46–0.92], P =0.02) and reduced likelihood of an early neurological recovery (aOR, 0.62 [95% CI, 0.44–0.91], P =0.01 and aOR, 1.37 [95% CI, 1.03–1.87], P =0.04, respectively). Conclusions: High-frequency BP oscillations after successful reperfusion may be harmful and associate with a decreased likelihood of neurological recovery and favorable functional outcomes. Rapid assessment of BP variability throughout the postreperfusion period is feasible and may allow for a more personalized BP management.

Visual functional outcomes of cataract surgery in the United States, Canada, Denmark, and Spain

2003 ◽  
Vol 29 (11) ◽  
pp. 2135-2142 ◽  
Author(s):  
Jens Christian Norregaard ◽  
Peter Bernth-Petersen ◽  
Jordi Alonso ◽  
Tavs Folmer Andersen ◽  
Gerard F. Anderson
Keyword(s):  
United States ◽  
Cataract Surgery ◽  
Functional Outcomes ◽  
The United States
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