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- (-) Stroke (34)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 34 Research Studies DisplayedGarg R, Prabhakaran S, Holl JL
Improving the accuracy of scores to predict gastrostomy after intracerebral hemorrhage with machine learning.
Gastrostomy placement after intracerebral hemorrhage indicates the need for continued medical care and predicts patient dependence. The objective of this study was to determine the optimal machine learning technique to predict gastrostomy. The investigators concluded that machine learning techniques other than logistic regression (eg, random forests, extreme gradient boost, and kth nearest neighbors) were significantly more accurate for predicting gastrostomy using the same independent variables.
AHRQ-funded; HS023437.
Citation: Garg R, Prabhakaran S, Holl JL .
Improving the accuracy of scores to predict gastrostomy after intracerebral hemorrhage with machine learning.
J Stroke Cerebrovasc Dis 2018 Dec;27(12):3570-74. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.026..
Keywords: Stroke
Borre ED, Goode A, Raitz G
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
This systematic review compared the strength of tools to predict stroke and bleeding risk in patients with atrial fibrillation (AF) taking blood thinners. Sixty-one studies were found to predict thromboembolic risk and 38 to predict bleeding risk.
AHRQ-funded; 290201500004I.
Citation: Borre ED, Goode A, Raitz G .
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
Thromb Haemost 2018 Dec;118(12):2171-87. doi: 10.1055/s-0038-1675400..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Blood Clots, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient-Centered Outcomes Research, Evidence-Based Practice
Williams CN, Piantino J, McEvoy C
The burden of pediatric neurocritical care in the United States.
This article attempts to quantify the burden of pediatric neurocritical care (PNCC) by developing national estimates of disease incidence, evaluating use of critical care interventions (CCI), and examining hospital outcomes. The Kids Inpatient Database (KID) was analyzed to evaluate cohorts with the following conditions: traumatic brain injury, neuro-infection, or inflammatory diseases; status epilepticus; stroke; hypoxic ischemic injury after cardiac arrest; or spinal cord injury.
AHRQ-funded; HS022981.
Citation: Williams CN, Piantino J, McEvoy C .
The burden of pediatric neurocritical care in the United States.
Pediatr Neurol 2018 Dec;89:31-38. doi: 10.1016/j.pediatrneurol.2018.07.013..
Keywords: Children/Adolescents, Critical Care, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Neurological Disorders, Stroke, Trauma
Desai RJ, Wyss R, Jin Y
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Use of disease risk score (DRS)-based confounding adjustment when estimating treatment effects on multiple outcomes is not well studied. In this empirical cohort study, the investigators compared dabigatran initiators and warfarin initiators with respect to risks of ischemic stroke and major bleeding in 12 sequential monitoring periods (90 days each), using data from the Truven Marketscan database (Truven Health Analytics, Ann Arbor, Michigan).
AHRQ-funded; HS022193.
Citation: Desai RJ, Wyss R, Jin Y .
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Am J Epidemiol 2018 Nov;187(11):2439-48. doi: 10.1093/aje/kwy130.
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Keywords: Blood Thinners, Cardiovascular Conditions, Medication, Outcomes, Research Methodologies, Risk, Stroke
Smith TM, Pappadis MR, Krishnan S
Stroke survivor and caregiver perspectives on post-stroke visual concerns and long-term consequences.
The purpose of this study was to explore the post-stroke visual concerns and consequences expressed by stroke survivors and caregivers using semistructured interviews conducted with a convenience sample of stroke survivors and caregivers recruited from either a community support group or skilled nursing and long-term care facilities.
AHRQ-funded; HS022134; HS024711.
Citation: Smith TM, Pappadis MR, Krishnan S .
Stroke survivor and caregiver perspectives on post-stroke visual concerns and long-term consequences.
Behav Neurol 2018 Oct 4;2018:1463429. doi: 10.1155/2018/1463429..
Keywords: Caregiving, Stroke
Hirayama A, Goto T, Faridi MK
Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.
The purpose of this study was to examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke. Results showed that, among 620,788 hospitalizations, advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.
Int J Stroke 2018 Oct;13(7):717-24. doi: 10.1177/1747493018772790..
Keywords: Elderly, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitalization, Stroke
Ali A, Zachrison KS, Eschenfeldt PC
Optimization of prehospital triage of patients with suspected ischemic stroke.
Prehospital routing algorithms for patients with suspected stroke because of large vessel occlusions should account for likelihood of benefit from endovascular therapy (EVT), risk of alteplase delays, and transport times. In this study, the investigators present a mathematical decision model that determines ideal prehospital routing recommendations for patients with suspected stroke because of large vessel occlusions, with consideration of patient characteristics and location at onset.
AHRQ-funded; HS024561.
Citation: Ali A, Zachrison KS, Eschenfeldt PC .
Optimization of prehospital triage of patients with suspected ischemic stroke.
Stroke 2018 Oct;49(10):2532-35. doi: 10.1161/strokeaha.118.022041..
Keywords: Emergency Medical Services (EMS), Stroke
Hong I, Karmarker A, Chan W
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Investigators explored variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. They found demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Additionally, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
AHRQ-funded; HS022134; HS024711.
Citation: Hong I, Karmarker A, Chan W .
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Am J Phys Med Rehabil 2018 Sep;97(9):636-45. doi: 10.1097/phm.0000000000000932..
Keywords: Transitions of Care, Hospital Discharge, Stroke, Cardiovascular Conditions, Nursing Homes, Rehabilitation
Moreno A, Schwamm LH, Siddiqui KA
Frequent hub-spoke contact is associated with improved spoke hospital performance: results from the Massachusetts General Hospital Telestroke Network.
This study investigated the association of a strong hub-spoke hospital connection with improved spoke hospital performance for acute ischemic stroke patients associated with the Massachusetts General Hospital Telestroke Network. Investigators identified 375 patients treated with tPA by conventional or telestroke methods from 2006-2015 with 16 spoke hospitals. There was a positive association between more frequent contact between a telestroke spoke and its hub and faster tPA delivery for patients.
AHRQ-funded; HS024561.
Citation: Moreno A, Schwamm LH, Siddiqui KA .
Frequent hub-spoke contact is associated with improved spoke hospital performance: results from the Massachusetts General Hospital Telestroke Network.
Telemed J E Health 2018 Sep;24(9):678-83. doi: 10.1089/tmj.2017.0252..
Keywords: Health Information Technology (HIT), Hospitals, Provider Performance, Quality of Care, Stroke, Telehealth
Lakshminarayan K, Westberg S, Northuis C
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Hypertension (HTN) is significantly under-treated in stroke survivors. The study authors examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control. They concluded that a mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors.
AHRQ-funded; HS021794.
Citation: Lakshminarayan K, Westberg S, Northuis C .
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Contemp Clin Trials 2018 Jul;70:24-34. doi: 10.1016/j.cct.2018.05.005..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Stroke, Cardiovascular Conditions
Regenhardt RW, Mecca AP, Flavin SA
Delays in the air or ground transfer of patients for endovascular thrombectomy.
This study’s objective was to examine associations between transfer time, modes of transfer, endovascular therapy (ET), and outcomes within a hub-and-spoke telestroke network. Results showed an association between longer transfer time and decreased likelihood of undergoing ET. Nocturnal transfers were associated with a substantial delay relative to daytime transfers. In contrast, delivery of tPA was not associated with delays, underscoring the impact of effective protocols at spoke hospitals. More efficient transfer may enable higher ET treatment rates.
AHRQ-funded; HS024561.
Citation: Regenhardt RW, Mecca AP, Flavin SA .
Delays in the air or ground transfer of patients for endovascular thrombectomy.
Stroke 2018 Jun;49(6):1419-25. doi: 10.1161/strokeaha.118.020618.
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Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Telehealth, Transitions of Care, Stroke
Krishnan S, Pappadis MR, Weller SC
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
This study explored the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities. Frequently mentioned outcome preferences by survivors were ability to walk (88 percent), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor's safety and wanted them to drive (53 percent), prevent falls, have home accommodations, and transfer independently.
AHRQ-funded; HS022134; HS024711.
Citation: Krishnan S, Pappadis MR, Weller SC .
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
Disabil Rehabil 2018 Jun;40(12):1401-09. doi: 10.1080/09638288.2017.1297855.
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Keywords: Caregiving, Patient-Centered Outcomes Research, Patient Safety, Rehabilitation, Stroke
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation: Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Stroke
Sterling MR, Durant RW, Bryan J
N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study.
Researchers compared the association of N-terminal pro B-type peptide (NT-proBNP) with risk of incident typical myocardial infarction (MI) and microsize MI in the REasons for Geographic and Racial Differences in Stroke Study. Over a median of 5 years of follow-up, there were 315 typical MI, 139 microsize MI, and 195 incident fatal coronary heart disease (CHD). NT-proBNP was independently and strongly associated with all CHD endpoints, with significantly greater risk observed for incident microsize MI.
AHRQ-funded; HS000066.
Citation: Sterling MR, Durant RW, Bryan J .
N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study.
BMC Cardiovasc Disord 2018 Apr 16;18(1):66. doi: 10.1186/s12872-018-0806-4.
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Keywords: Heart Disease and Health, Racial and Ethnic Minorities, Risk, Stroke
Fudim M, Liu PR, Shrader P
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. In order to better understand MRA use and subsequent outcomes, the investigators performed a retrospective cohort study of the contemporary ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
AHRQ-funded; HS021092.
Citation: Fudim M, Liu PR, Shrader P .
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007987..
Keywords: Cardiovascular Conditions, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention, Registries, Stroke
Mullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation: Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Mefford MT, Rosenson RS, Cushman M
PCSK9 variants, low-density lipoprotein cholesterol, and neurocognitive impairment: Reasons for Geographic and Racial Differences in Stroke Study(REGARDS).
Researchers examined if there was an association between low lifelong exposure to PCSK9 levels and lower levels of low-density lipoprotein cholesterol with neurocognitive function in blacks. Data was analyzed from subjects in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The mean sample age was 64, with 62% women but a low prevalence of neurocognitive impairments at any level (6.3% by CERAD battery, and 15.4% by SIS definitions). No association with found.
AHRQ-funded; HS013852.
Citation: Mefford MT, Rosenson RS, Cushman M .
PCSK9 variants, low-density lipoprotein cholesterol, and neurocognitive impairment: Reasons for Geographic and Racial Differences in Stroke Study(REGARDS).
Circulation 2018 Mar 20;137(12):1260-69. doi: 10.1161/circulationaha.117.029785..
Keywords: Heart Disease and Health, Racial and Ethnic Minorities, Risk, Stroke
Saber Tehrani AS, Kattah JC, Kerber KA
Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls.
Diagnosing cerebrovascular causes of acute dizziness and vertigo is both important and difficult. It is not routinely done well in current clinical ED practice. Current best evidence suggests an approach emphasizing dizziness timing and triggers, focused ocular motor examinations, and MRI, as needed. Alternative strategies to disseminate this approach may be required.
AHRQ-funded; HS022258.
Citation: Saber Tehrani AS, Kattah JC, Kerber KA .
Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls.
Stroke 2018 Mar;49(3):788-95. doi: 10.1161/strokeaha.117.016979.
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Keywords: Diagnostic Safety and Quality, Imaging, Stroke
Mendelson SJ, Courtney DM, Gordon EJ
National practice patterns of obtaining informed consent for stroke thrombolysis.
No standard approach to obtaining informed consent for stroke thrombolysis with tPA (tissue-type plasminogen activator) currently exists. The researchers aimed to assess current nationwide practice patterns of obtaining informed consent for tPA. They concluded that most clinicians always or often require informed consent for stroke thrombolysis.
AHRQ-funded; HS025330.
Citation: Mendelson SJ, Courtney DM, Gordon EJ .
National practice patterns of obtaining informed consent for stroke thrombolysis.
Stroke 2018 Mar;49(3):765-67. doi: 10.1161/strokeaha.117.020474.
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Keywords: Practice Patterns, Stroke
Blackburn J, Albright KC, Haley WE
Men lacking a caregiver have greater risk of long-term nursing home placement after stroke.
The purpose of this study was to understand how the availability of a caregiver can affect nursing home placement after ischemic stroke and how this affects different subgroups differently. The investigators found that in men aged 65 and older who have survived an ischemic stroke, the lack of an available caregiver is associated with triple the risk of NHP within 5 years.
AHRQ-funded; HS023009.
Citation: Blackburn J, Albright KC, Haley WE .
Men lacking a caregiver have greater risk of long-term nursing home placement after stroke.
J Am Geriatr Soc 2018 Jan;66(1):133-39. doi: 10.1111/jgs.15166..
Keywords: Cardiovascular Conditions, Caregiving, Elderly, Long-Term Care, Men's Health, Nursing Homes, Stroke
Sanders BD, Davis MG, Holley SL
Pregnancy-associated stroke.
This article reviews assessment and treatment of pregnant and postpartum women experiencing stroke. There are 2 main types of stroke, ischemic and hemorrhagic that present similar symptoms but have very different pathophysiology and treatment. This article provides guidance for subsequent maternity and primary care for front-line perinatal care providers.
AHRQ-funded; HS024733.
Citation: Sanders BD, Davis MG, Holley SL .
Pregnancy-associated stroke.
J Midwifery Womens Health 2018 Jan;63(1):23-32. doi: 10.1111/jmwh.12720..
Keywords: Cardiovascular Conditions, Maternal Care, Pregnancy, Primary Care, Risk, Stroke, Women
Mullen MT, Wiebe DJ, Bowman A
Disparities in accessibility of certified primary stroke centers.
These authors examined the proportion of the U.S. population with less than 60-minute access to Primary Stroke Centers (PSCs). They found significant geographic disparities in access to the PSCs. Stroke belt States have a higher burden of stroke and more limited access to PSCs.
AHRQ-funded; HS013852; HS017960; HS010914
Citation: Mullen MT, Wiebe DJ, Bowman A .
Disparities in accessibility of certified primary stroke centers.
Stroke. 2014 Nov;45(11):3381-8. doi: 10.1161/strokeaha.114.006021..
Keywords: Stroke, Access to Care, Disparities
Adeoye O, Albright KC, Carr BG
Geographic access to acute stroke care in the United States.
In this article the authors describe access of the US population to all facilities that actually provide intravenous recombinant tissue-type plasminogen activator (r-tPA) or endovascular therapy for acute ischemic stroke. The investigators concluded that more than half of the US population has geographic access to hospitals that actually deliver acute stroke care but treatment rates remain low.
AHRQ-funded; HS013852.
Citation: Adeoye O, Albright KC, Carr BG .
Geographic access to acute stroke care in the United States.
Stroke 2014 Oct;45(10):3019-24. doi: 10.1161/strokeaha.114.006293.
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Keywords: Access to Care, Stroke
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
AHRQ-funded; HS013852.
Citation: Boehme AK, Rawal PV, Lyerly MJ .
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
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Keywords: Decision Making, Diagnostic Safety and Quality, Risk, Stroke
Petrov ME, Howard VJ, Kleindorfer D
Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study.
The authors investigated the relation between sleep medication use and incident stroke. At the sleep assessment, 9.6% of the participants used prescription sleep medication and 11.1% used over-the-counter sleep aids. Over an average follow-up of 3.3 ± 1.0 years, 297 stroke events occurred. The authors found that over-the-counter sleep medication use was associated with increased risk of incident stroke; however, there was no significant association with prescription sleep medications. They concluded that over-the-counter sleep medication use may independently increase the risk of stroke beyond other risk factors in middle-aged to older individuals with no history of stroke.
AHRQ-funded; HS013852.
Citation: Petrov ME, Howard VJ, Kleindorfer D .
Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study.
J Stroke Cerebrovasc Dis 2014 Sep;23(8):2110-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.03.025.
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Keywords: Medication: Safety, Medication, Risk, Sleep Problems, Stroke, Cardiovascular Conditions, Racial and Ethnic Minorities