Risk of stroke after emergency department visits for neurologic complaints
Risk of stroke after emergency department visits for neurologic complaints
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DOI：
10.1212/cpj.0000000000000673
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发表时间：
2020-04-01
影响因子：
2.2
通讯作者：
Prabhakaran, Shyam
中科院分区：
文献类型：
--
作者：
Rosenman, Marc B.;Oh, Elissa;Prabhakaran, Shyam
目的评估从急诊科（艾德）出院但未诊断为TIA或卒中的老年患者发生后续卒中的风险。方法使用来自大型城市、大学医院和社区医院的电子健康记录数据，我们分析了60-89岁的患者，这些患者从艾德出院回家，没有国际疾病和相关健康问题统计分类，第9或第10修订版诊断为TIA或卒中。根据首次艾德访视期间是否存在头部CT以及是否存在提示TIA或卒中的主诉（“症状”），我们创建了4个互斥组（第1组，参考：头部CT无，症状无;第2组：头部CT无，症状有;第3组：头部CT有，症状无;第4组：头部CT有，症状有）。我们计算了首次访视后30天、90天和365天的卒中发生率，并使用多变量logistic回归估计后续卒中的比值比（OR）。结果在35，622名患者（平均年龄70岁，59%为女性，16%为非裔美国人）中，365天内未调整的中风率如下：第4组：2.5%;第3组：1.1%;第2组：0.69%;第1组：0.54%。第4组中卒中的校正OR为3.30（95%置信区间[CI]，1.61-6.76），第3组为1.56（95% CI，1.16-2.09），第2组为0.61（95% CI，0.22-1.67）。结论：在从艾德出院但未诊断为TIA或卒中的患者中，头部CT和/或特定神经系统症状的发生为后续卒中建立了具有临床意义的风险梯度。
Objective To assess the risk of subsequent stroke among older patients discharged from an emergency department (ED) without a diagnosis of TIA or stroke. Methods Using electronic health record data from a large urban, university hospital and a community-based hospital, we analyzed patients aged 60-89 years discharged to home from the ED without an International Statistical Classification of Diseases and Related Health Problems, 9th or 10th Revision diagnosis of TIA or stroke. Based on the presence/absence of a head CT and the presence/absence of a chief complaint suggestive of TIA or stroke ("symptoms") during the index ED visit, we created 4 mutually exclusive groups (group 1, reference: head CT no, symptoms no; group 2: head CT no, symptoms yes; group 3: head CT yes, symptoms no; and group 4: head CT yes, symptoms yes). We calculated rates of stroke in the 30, 90, and 365 days after the index visit and used multivariable logistic regression to estimate odds ratios (ORs) for subsequent stroke. Results Among 35,622 patients (mean age 70 years, 59% women, and 16% African American), unadjusted rates of stroke in 365 days were as follows: group 4: 2.5%; group 3: 1.1%; group 2: 0.69%; and group 1: 0.54%. The adjusted OR for stroke was 3.30 (95% confidence interval [CI], 1.61-6.76) in group 4, 1.56 (95% CI, 1.16-2.09) in group 3, and 0.61 (95% CI, 0.22-1.67) in group 2. Conclusions Among patients discharged from the ED without a diagnosis of TIA or stroke, the occurrence of a head CT and/or specific neurologic symptoms established a clinically meaningful risk gradient for subsequent stroke.