Mei-Chiun Tseng

Prediction of Length of Stay of First-Ever Ischemic Stroke

Background and Purpose— Accurate information about hospital resource utilization is necessary for management of healthcare service. The purpose of this study was to determine the demographic and clinical predictors of length of hospital stay (LOS) of acute care hospitalization for first-ever ischemic stroke patients. Methods— A group of 330 patients who suffered from first-ever ischemic stroke and were consecutively admitted to a medical center in southern Taiwan were followed prospectively. Because our intention was to identify the major predictors of LOS from the information available at admission, we evaluated only those factors that could be assessed at the time of admission. Univariate analysis and multiple regression analysis were used to identify the main predictors of LOS. Results— The median LOS was 7 days (mean, 11 days; range, 1 to 122 days). Among the prespecified demographic and clinical characteristics, National Institutes of Health Stroke Scale (NIHSS) score at admission, the quadratic term of the initial NIHSS score, modified Barthel Index score at admission, small-vessel occlusion stroke, sex, and smoking were the main explanatory factors for LOS. In particular, for each 1-point increase in the total score of NIHSS, LOS increased approximately 1 day for patients with mild or moderate (score 0 to 15 points) neurological impairments, while LOS decreased approximately 1 day for patients with severe (score >15 points) neurological impairments. Conclusions— The severity of stroke, as rated by the total score on NIHSS, is an important factor that influences LOS after acute stroke hospitalization.

Blood Biomarkers in the Diagnosis of Ischemic Stroke A Systematic Review

Background and Purpose— The diagnosis of ischemic stroke can be difficult. CT may be normal in the early stages of ischemic stroke or in patients with minor symptoms and MR is not always possible. Many blood markers have been proposed for the diagnosis of stroke in the acute setting. Methods and Results— We have systematically reviewed the diagnostic literature and found 21 studies testing 58 single biomarkers and 7 panels of several biomarkers. Although all show either a high sensitivity or specificity, there are limitations in the design and reporting of all the studies that mean no biomarker can be recommended for use in clinical practice. Conclusions— We make recommendations for the design and reporting of studies of diagnostic blood biomarkers in stroke.

Prehospital Delay After Acute Stroke in Kaohsiung, Taiwan

Background and Purpose— Successful acute stroke intervention depends on early hospital presentation. Our study aimed to examine the extent of and factors associated with prehospital delays after acute stroke in Taiwan, where people are new to thrombolytic therapy for stroke. Methods— Data were prospectively collected from 196 patients admitted with acute stroke who presented to the emergency department (ED) of the study hospital within 48 hours of symptom onset before intravenous recombinant tissue plasminogen activator was approved. Prehospital delay was defined as time from symptom onset to the ED arrival. Univariate and multivariable regression analyses were conducted to evaluate factors influencing delay in ED presentation and delay in decision to seek medical help. Results— The median interval between symptom onset and decision to seek medical contact was 90 minutes; the median interval between symptom onset and ED arrival was 335 minutes. The time from symptom onset to first call for medical help accounted for 45% (95% confidence interval, 41 to 50) of the prehospital delay. Advanced age delayed the decision to seek medical help, whereas stroke severity reduced the risk for this delay. Conclusions— The time interval between symptom onset and the decision to call for medical care is far from optimal and is the underlying cause of prolonged prehospital delay. Educational efforts to reduce extent of delay are urgently needed.

Costs of Acute Care of First-Ever Ischemic Stroke in Taiwan

Background and Purpose— We sought to investigate the direct costs of acute hospitalization for patients with first-ever ischemic stroke in Taiwan. Methods— Data were prospectively collected from 360 first-ever ischemic stroke patients. Hospital charges were used for analysis. Multiple linear regression analysis was used to identify the main factors influencing costs. Results— Mean age was 64.9 years (median, 67.0 years), and 58% were male. Mean National Institutes of Health Stroke Scale (NIHSS) score at admission was 9.4 (median, 6.0). Mean initial score of modified Barthel Index was 10.7 (median, 12.0). Median length of stay was 7 days (range, 1 to 122 days). In-hospital mortality was 8%. Overall, median cost per patient was 26 326 New Taiwan dollars (NTD) (original currency) or

Readmission after stroke in a hospital-based registry Risk, etiologies, and risk factors

841; median cost per day was 3777 NTD or

Readmission after hospitalization for stroke in Taiwan: results from a national sample.

121. Median costs for patients with initial NIHSS score 0 to 6, 7 to 15, and 16 to 38 were 20 365 NTD (

Predicting 3-month Mortality Among Patients Hospitalized for First-ever Acute Ischemic Stroke

650), 31 954 NTD (

Code stroke: A mismatch between number of activation and number of thrombolysis

1020), and 62 653 NTD (

Temperature-Lowering Therapy for Acute Stroke

2000), respectively. Daily component (physician and ward charges) accounted for approximately 38% of total costs. Initial NIHSS score, small-vessel occlusion, admission to intensive care unit, sex, and smoking had significant impacts on costs. Conclusions— Apart from providing cost estimates, we note that stroke severity strongly affects costs.

Oxfordshire Community Stroke Project classification but not NIHSS predicts symptomatic intracerebral hemorrhage following thrombolysis

Objective: Readmission among stroke survivors is common and costly. This prospective cohort study aimed to explore the readmission risk, causes, and risk factors after discharge from stroke hospitalization in Taiwan. Methods: Hospitalized patients with acute stroke between August 1, 2006, and December 31, 2008, were prospectively under continuous surveillance on the medical records for any readmission. The main reasons for readmission were categorized by chart review as recurrent stroke, neurologic sequelae of stroke, other cardiovascular event, infection, gastrointestinal ulcer with bleeding, and others. Kaplan-Meier method was used to estimate the probabilities of readmission over time and Cox proportional hazards models were used to evaluate the risk factors for the first readmission. Results: Of the 2,657 study patients, rehospitalization occurred in 815 (31%) within 1 year after discharge. The probability of readmission at 30 days was 10% (95% confidence interval 9%–11%), at 90 days 17% (16%–19%), at 180 days 24% (22%–26%), and at 360 days 36% (34%–38%). The most frequent reasons for rehospitalization were infection (28%), recurrent stroke (18%), and other cardiovascular event (10%). Increasing age, previous stroke/TIA, atrial fibrillation, coronary artery disease, having complications at the index hospitalization, longer length of stay, and dependency at discharge were the independent predictors for readmission. Conclusions: Stroke survivors have high likelihood of readmission within 1 year following discharge, with infections and recurrent vascular events being the most common reasons. Identification of high-risk subgroups might foster preventive interventions.