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  • 1
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    Online Resource
    Individual and System Contributions to Race and Sex Disparities in Thrombolysis Use for Stroke Patients in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 4 ( 2017-04), p. 990-997
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 4 ( 2017-04), p. 990-997
    Abstract: Intravenous thrombolysis (IVT) is underutilized in ethnic minorities and women. To disentangle individual and system-based factors determining disparities in IVT use, we investigated race/sex differences in IVT utilization among hospitals serving varying proportions of minority patients. Methods— Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of minority patients admitted with stroke ( 〈 25% minority patients [white hospitals], 25% to 50% minority patients [mixed hospitals] , or 〉 50% minority patients [minority hospitals]). Logistic regression was used to evaluate the association between race/sex and IVT use within and between the different hospital strata. Results— Among 337 201 stroke admissions, white men had the highest odds of IVT among all race/sex groups in any hospital strata, and the odds of IVT for white men did not differ by hospital strata. For white women and minority men, the odds of IVT were significantly lower in minority hospitals compared with white hospitals (odds ratio, 0.83; 95% confidence interval, 0.71–0.97, for white women; and odds ratio, 0.82; 95% confidence interval, 0.69–0.99, for minority men). Race disparities in IVT use among women were observed in white hospitals (odds ratio, 0.88; 95% confidence interval, 0.78–0.99, in minority compared with white women), but not in minority hospitals (odds ratio, 0.94, 95% confidence interval, 0.82–1.09). Sex disparities in IVT use were observed among whites but not among minorities. Conclusions— Minority men and white women have significantly lower odds of IVT in minority hospitals compared with white hospitals. IVT use in white men does not differ by hospital strata.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.015056
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Novel Score Predicting Gastrostomy Tube Placement in Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 1 ( 2015-01), p. 31-36
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 1 ( 2015-01), p. 31-36
    Abstract: Dysphagia after intracerebral hemorrhage (ICH) contributes significantly to morbidity, often necessitating placement of a percutaneous endoscopic gastrostomy (PEG) tube. This study describes a novel risk prediction score for PEG placement after ICH. Methods— We retrospectively analyzed data from 234 patients with ICH presenting during a 4-year period. One hundred eighty-nine patients met inclusion criteria. The sample was randomly divided into a development and a validation cohort. Logistic regression was used to develop a risk score by weighting predictors of PEG placement based on strength of association. Results— Age (odds ratio [OR], 1.64 per 10-year increase in age; 95% confidence interval [CI] , 1.02–2.65), black race (OR, 3.26; 95% CI, 0.96–11.05), Glasgow Coma Scale (OR, 0.80; 95% CI, 0.62–1.03), and ICH volume (OR, 1.38 per 10-mL increase in ICH volume) were independent predictors of PEG placement. The final model for score development achieved an area under the curve of 0.7911 (95% CI, 0.6931–0.8892) in the validation group. The score was named the GRAVo score: Glasgow Coma Scale ≤12 (2 points), Race (1 point for black), Age 〉 50 years (2 points), and ICH Volume 〉 30 mL (1 point). A score 〉 4 was associated with ≈12× higher odds of PEG placement when compared with a score ≤4 (OR, 11.81; 95% CI, 5.04–27.66), predicting PEG placement with 46.55% sensitivity and 93.13% specificity. Conclusions— The GRAVo score, combining information about Glasgow Coma Scale, race, age, and ICH volume, may be a useful predictor of PEG placement in ICH patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.006891
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Racial Differences in Palliative Care Use After Stroke in Majority-White, Minority-Serving, and Racially Integrated U.S. Hospitals
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Critical Care Medicine Vol. 45, No. 12 ( 2017-12), p. 2046-2054
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 12 ( 2017-12), p. 2046-2054
    Abstract: Racial/ethnic differences in palliative care resource use after stroke have been recognized, but it is unclear whether patient or hospital characteristics drive this disparity. We sought to determine whether palliative care use after intracerebral hemorrhage and ischemic stroke differs between hospitals serving varying proportions of minority patients. Design: Population-based cross-sectional study. Setting: Inpatient hospital admissions from the Nationwide Inpatient Sample between 2007 and 2011. Patients: A total of 46,735 intracerebral hemorrhage and 331,521 ischemic stroke cases. Interventions: Palliative care use. Measurements and Main Results: Intracerebral hemorrhage and ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic minority stroke patients ( 〈 25% minorities [“white hospitals”], 25–50% minorities [“mixed hospitals”] , or 〉 50% minorities [“minority hospitals”]). Logistic regression was used to evaluate the association between race/ethnicity and palliative care use within and between the different hospital strata. Stroke patients receiving care in minority hospitals had lower odds of palliative care compared with those treated in white hospitals, regardless of individual patient race/ethnicity (adjusted odds ratio, 0.65; 95% CI, 0.50–0.84 for intracerebral hemorrhage and odds ratio, 0.62; 95% CI, 0.50–0.77 for ischemic stroke). Ethnic minorities had a lower likelihood of receiving palliative care compared with whites in any hospital stratum, but the odds of palliative care for both white and minority intracerebral hemorrhage patients was lower in minority compared with white hospitals (odds ratio, 0.66; 95% CI, 0.50–0.87 for white and odds ratio, 0.64; 95% CI, 0.46–0.88 for minority patients). Similar results were observed in ischemic stroke. Conclusions: The odds of receiving palliative care for both white and minority stroke patients is lower in minority compared with white hospitals, suggesting system-level factors as a major contributor to explain race disparities in palliative care use after stroke.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000002762
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2034247-0
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  • 4
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    Online Resource
    Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of the American Heart Association Vol. 5, No. 8 ( 2016-08-08)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 8 ( 2016-08-08)
    Abstract: Intracerebral hemorrhage ( ICH ) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients. Methods and Results We used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample ( NIS ). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS , 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale ( GCS ; P =0.016), ICH volume ( P =0.013), intraventricular haemorrhage ( IVH ; P =0.023), and diabetes mellitus ( P =0.037) were predictors of mortality in blacks, whereas GCS ( P =0.007), ICH volume ( P =0.005), age ( P =0.002), chronic kidney disease ( P =0.003), and smoking ( P =0.010) predicted mortality in whites. Among patients with IVH , blacks had over 7 times higher odds of mortality compared to whites (odds ratio [ OR ], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus ( OR , 2.76; P =0.026). In the NIS , black ICH patients had higher rates of external ventricular drain ( EVD ) placement compared to whites (9.7% vs 5.0%; P 〈 0.001) and were more likely to develop hydrocephalus ( OR , 1.32; 95% CI , 1.20–1.46). Comparison of a race‐specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race. Conclusions IVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.116.003540
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2653953-6
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  • 5
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    Online Resource
    Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 4 ( 2016-04), p. 964-970
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 4 ( 2016-04), p. 964-970
    Abstract: Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding of patients after intracerebral hemorrhage (ICH). We sought to determine whether PEG placement after ICH differs by race and socioeconomic status. Methods— Patient discharges with ICH as the primary diagnosis from 2007 to 2011 were queried from the Nationwide Inpatient Sample. Logistic regression was used to evaluate the association between race, insurance status, and household income with PEG placement. Results— Of 49 946 included ICH admissions, a PEG was placed in 4464 (8.94%). Among PEG recipients, 47.2% were minorities and 15.6% were Medicaid enrollees, whereas 33.7% and 8.2% of patients without a PEG were of a race other than white and enrolled in Medicaid, respectively ( P 〈 0.001). Compared with whites, the odds of PEG were highest among Asians/Pacific Islanders (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.32–1.99) and blacks (OR 1.42, 95% CI 1.28–1.59). Low household income (OR 1.25, 95% CI 1.09–1.44 in lowest compared with highest quartile) and enrollment in Medicaid (OR 1.36, 95% CI 1.17–1.59 compared with private insurance) were associated with PEG placement. Racial disparities (minorities versus whites) were most pronounced in small/medium-sized hospitals (OR 1.77, 95% CI 1.43–2.20 versus OR 1.31, 95% CI 1.17–1.47 in large hospitals; P value for interaction 0.011) and in hospitals with low ICH case volume (OR 1.58, 95% CI 1.38–1.81 versus OR 1.29, 95% CI 1.12–1.50 in hospitals with high ICH case volume; P value for interaction 0.007). Conclusions— Minority race, Medicaid enrollment, and low household income are associated with PEG placement after ICH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011712
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Online Resource
    ICAT: a simple score predicting critical care needs after thrombolysis in stroke patients
    Springer Science and Business Media LLC ; 2015
    In:  Critical Care Vol. 20, No. 1 ( 2015-12)
    Details
    In: Critical Care, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2015-12)
    Type of Medium: Online Resource
    ISSN: 1364-8535
    URL: Article
    DOI: 10.1186/s13054-016-1195-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 2051256-9
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  • 7
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    Troponin elevation predicts critical care needs and in-hospital mortality after thrombolysis in white but not black stroke patients
    Elsevier BV ; 2016
    In:  Journal of Critical Care Vol. 32 ( 2016-04), p. 3-8
    Details
    In: Journal of Critical Care, Elsevier BV, Vol. 32 ( 2016-04), p. 3-8
    Type of Medium: Online Resource
    ISSN: 0883-9441
    URL: Article
    DOI: 10.1016/j.jcrc.2015.11.012
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2041640-4
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  • 8
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    Minority race and male sex as risk factors for non-beneficial gastrostomy tube placements after stroke
    Public Library of Science (PLoS) ; 2018
    In:  PLOS ONE Vol. 13, No. 1 ( 2018-1-19), p. e0191293-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 13, No. 1 ( 2018-1-19), p. e0191293-
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
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    URL: Article
    URL: Article
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    URL: Article
    DOI: 10.1371/journal.pone.0191293
    DOI: 10.1371/journal.pone.0191293.g001
    DOI: 10.1371/journal.pone.0191293.t001
    DOI: 10.1371/journal.pone.0191293.t002
    DOI: 10.1371/journal.pone.0191293.t003
    DOI: 10.1371/journal.pone.0191293.s001
    DOI: 10.1371/journal.pone.0191293.s002
    DOI: 10.1371/journal.pone.0191293.s003
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2018
    detail.hit.zdb_id: 2267670-3
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  • 9
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    Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 96, No. 20 ( 2021-05-18), p. e2458-e2468
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 20 ( 2021-05-18), p. e2458-e2468
    Abstract: To develop a risk prediction score identifying patients with intracerebral hemorrhage (ICH) at low risk for critical care. Methods We retrospectively analyzed data of 451 patients with ICH between 2010 and 2018. The sample was randomly divided into a development and a validation cohort. Logistic regression was used to develop a risk score by weighting independent predictors of intensive care unit (ICU) needs according to strength of association. The risk score was tested in the validation cohort and externally validated in a dataset from another institution. Results The rate of ICU interventions was 80.3%. Systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, intraventricular hemorrhage (IVH), and ICH volume were independent predictors of critical care, resulting in the following point assignments for the Intensive Care Triaging in Spontaneous Intracerebral Hemorrhage (INTRINSIC) score: SBP 160 to 190 mm Hg (1 point), SBP 〉 190 mm Hg (3 points); GCS 8 to 13 (1 point), GCS 〈 8 (3 points); ICH volume 16 to 40 cm 3 (1 point), ICH volume 〉 40 cm 3 (2 points); and presence of IVH (1 point), with values ranging between 0 and 9. Among patients with a score of 0 and no ICU needs during their emergency department stay, 93.6% remained without critical care needs. In an external validation cohort of patients with ICH, the INTRINSIC score achieved an area under the receiver operating characteristic curve of 0.823 (95% confidence interval 0.782–0.863). A score 〈 2 predicted the absence of critical care needs with 48.5% sensitivity and 88.5% specificity, and a score 〈 3 predicted the absence of critical care needs with 61.7% sensitivity and 83.0% specificity. Conclusion The INTRINSIC score identifies patients with ICH who are at low risk for critical care interventions. Classification of Evidence This study provides Class II evidence that the INTRINSIC score identifies patients with ICH at low risk for critical care interventions.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000011927
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Racial Differences in Utilization of Life-Sustaining vs Curative Inpatient Procedures After Stroke
    American Medical Association (AMA) ; 2016
    In:  JAMA Neurology Vol. 73, No. 9 ( 2016-09-01), p. 1151-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 73, No. 9 ( 2016-09-01), p. 1151-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2016.1914
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2016
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