Kevin Walsh

Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years

In Britain, as in many other countries, back pain is a major cause of disability, especially in adults of working age. During the decade to 1993, outpatient attendances for back pain rose fivefold, and the number of days of incapacity from back disorders for which social security benefits were paid more than doubled.1 It is unclear whether this represents an increase in the occurrence of diseases affecting the back or a change in peoples behaviour when they have symptoms. To address this question we compared the prevalence of low back pain and associated disability in two postal surveys 10 years apart.

Reproducibility of histories of low-back pain obtained by self-administered questionnaire.

To test the repeatability of information about low-back pain elicited by self-administered questionnaire, histories obtained from 225 men and women were compared at an interval of 12 months. There was good agreement on whether subjects had ever suffered low-back pain (K = 0.82) and on whether the pain had ever led to consultation with a general practitioner (K = 0.76) or absence from work (K = 0.76). Information about the speed of onset of symptoms as well as histories of associated sciatica and disability for everyday activities were less reproducible. Epidemiologic studies based on such data must be interpreted with appropriate caution.

The SOAR Stroke Score Predicts Inpatient and 7-Day Mortality in Acute Stroke

Background and Purpose— An accurate prognosis is useful for patients, family, and service providers after acute stroke. Methods— We validated the Stroke subtype, Oxfordshire Community Stroke Project Classification, Age, and prestroke Rankin stroke score in predicting inpatient and 7-day mortality using data from 8 National Health Service hospital trusts in the Anglia Stroke and Heart Clinical Network between September 2008 and April 2011. Results— A total of 3547 stroke patients (ischemic, 92%) were included. An incremental increase of inpatient and 7-day mortality was observed with increase in Stroke subtype, Oxfordshire Community Stroke Project Classification, Age, and prestroke Rankin stroke score. Using a cut-off of ≥3, the area under the receiver operator curves values for inpatient and 7-day mortality were 0.80 and 0.82, respectively. Conclusions— A simple score based on 4 easily obtainable variables at the point of care may potentially help predict early stroke mortality.

Evaluation of stroke services in Anglia stroke clinical network to examine the variation in acute services and stroke outcomes

BackgroundStroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors.Methods/DesignWe will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses.DiscussionThis study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.

The SOAR stroke score predicts hospital length of stay in acute stroke: an external validation study

The objective of this study is to externally validate the SOAR stroke score (Stroke subtype, Oxfordshire Community Stroke Project Classification, Age and prestroke modified Rankin score) in predicting hospital length of stay (LOS) following an admission for acute stroke.

Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke.

BACKGROUND Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. METHODS We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. RESULTS Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]). CONCLUSIONS Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.