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  • 1
    Online Resource
    Online Resource
    Abstract TP169: Factors Associated With Intracerebral Hematoma In Patients With Aneurysmal Subarachnoid Hemorrhage In Vietnam: A Multicenter Prospective Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Early ICH expansion is associated with a higher rate of poor outcomes and death in aSAH patients, especially in limited-resource settings. This study aimed to investigate the impact of ICH expansion on the outcomes and the factors related to an ICH expansion in aSAH patients in an LMIC. Hypothesis: Understanding factors related to ICH after an aneurysmal rupture in different countries, particularly in limited-resource regions, is crucial for reducing poor outcomes and mortality. Methods: We performed a multicenter prospective cohort study of patients (≥18 years) presenting with aSAH at three central hospitals in Hanoi, Vietnam, from August 2019 to June 2021. We collected data on the demographics, baseline characteristics, management, and outcomes and compared these data between patients who had an ICH expansion (defined as ICH detected on an admission CT scan) and patients who did not. We assessed factors associated with ICH expansion on admission using logistic regression. Results: Of 415 patients, 198 (47.7%) were men, and the median age was 57.0 years (IQR: 48.0-67.0). ICH expansion accounted for 20.5% (85/415) of aSAH patients. There was a significant difference in the 90-day poor outcomes (43.5%; 37/85 and 29.1%; 96/330; p=0.011) and 90-day mortality (36.5%; 31/85 and 20.0%; 66/330; p=0.001) between patients who had ICH and patients who did not have ICH expansion. The multivariate analysis showed that systolic BP of 140 mmHg or more (OR: 2.674; 95% CI: 1.372-5.214), WFNS grades II (OR: 3.683; 95% CI: 1.250-10.858) to V (OR: 6.912; 95% CI: 2.553-18.709), and a ruptured MCA aneurysm (OR: 3.717; 95% CI: 1.848-7.477) were independent predictors of ICH expansion. Conclusions: In our study, ICH accounted for a substantial proportion of aSAH patients and contributed significantly to a high rate of poor outcomes and death. On admission, a higher systolic BP, a worse neurological status, and a ruptured MCA aneurysm were independent predictors of ICH expansion. This study indicates independent predictors of an early ICH expansion, such as a higher admission systolic BP and a worse initial neurological status, after aneurysmal ruptures that require only a clinical examination and, therefore, may be particularly valuable in resource-limited settings.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.TP169
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Abstract TP242: Predictive Validity of the Modified World Federation of Neurosurgical Societies Subarachnoid Hemorrhage Grading System (Modified WFNS Scale) for the Outcome of Patients With Aneurysmal Subarachnoid Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: Evaluating the prognosis of aSAH patients who may be at risk of poor outcomes using grading systems is one way to make a better decision on treatment for these patients. This study compared the accuracy of modified WFNS, WFNS, and Hunt and Hess (H & H) scales in predicting the aSAH patient's outcome. Methods: From August 2019 to June 2021, we conducted a multicenter prospective cohort study on aSAH adult patients in three central hospitals in Hanoi, Vietnam. The primary outcome was the 90-day poor outcome, measured by scores of 4-6 on mRS. We calculated areas under the receiver operator characteristic (ROC) curve (AUROCs) to determine how well the grading scales could predict patient prognosis upon admission. We also used ROC curve analysis to find the best cut-off value for each scale. We made comparisons of AUROCs using Z-statistics and compared 90-day mean mRS scores among intergrades using the pairwise multiple-comparison test. Finally, we used logistic regression to identify factors associated with the 90-day poor outcome. Results: Of 415 patients, 32% had a 90-day poor outcome. Modified WFNS (AUROC: 0.839 [95% CI: 0.795-0.883]; cut-off value≥2.50), WFNS (AUROC: 0.837 [95% CI: 0.793-0.881] ; cut-off value≥3.5), and H & H scales (AUROC: 0.836 [95% CI: 0.791-0.881]; cut-off value≥3.5) were all good at predicting patient prognosis on day 90th after ictus. However, there were no significant differences between AUROCs of these scales. Only grades IV and V of modified WFNS (3.75±2.46 vs. 5.24±1.68, p=0.026), WFNS (3.75±2.46 vs. 5.24±1.68, p=0.026), and H & H scales (2.96±2.60 vs. 4.97±1.87, p 〈 0.001) showed a significant difference in the 90-day mean mRS scores. In the multivariable models, with the same set of confounding variables, modified WFNS grade of III-V (adjusted OR (AOR): 9.090; 95% CI: 3.494-23.648) was more strongly associated with increased risk of the 90-day poor outcome compared to WFNS grade of IV-V (AOR: 6.383; 95% CI: 2.661-15.310) or H & H grade of IV-V (AOR: 6.146; 95% CI: 2.584-14.620). Conclusions: In this study modified WFNS, WFNS, and H & H scales all had good discriminatory abilities for the prognosis of aSAH patients. Because of better effect size in predicting poor outcomes, the modified WFNS scale seems preferable to the WFNS and H & H scales.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.TP242
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 3
    Online Resource
    Online Resource
    Abstract 148: No Bystander Cardiopulmonary Resuscitation For Out-Of-Hospital Cardiac Arrest In Vietnam: Impact On The Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Bystander CPR is not often performed on OHCA patients, particularly in limited-resource regions. This study aimed to investigate the rate of OHCA patients who did not receive bystander CPR and its impact on the outcomes in an LMIC. Hypothesis: Understanding the reasons bystanders are reluctant to call EMS and how no bystander CPR impacts the outcomes of OHCA patients are crucial for improving survival in Vietnam. Methods: We performed a multicenter prospective cohort study of OHCA patients (≥18 years) presenting to three central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes and compared these data between patients who did not receive bystander CPR and patients who did. Using logistic regression, we assessed factors associated with survival and good neurological function on discharge (a CPC score of 1 or 2). Results: Of 521 patients, 388 (74.5%) were male, and the mean age was 56.71 years (SD: 17.32). Although most cardiac arrests (68.7%; 358/521) occurred at home and 67.9% (353/520) were witnessed by bystanders, a high rate (77.9%, 406/521) of these patients did not receive bystander CPR. Only half of the patients were taken by EMS (8.1%, 42/521) or private ambulance (42.8%, 223/521); 50.8% (133/262) of whom were given resuscitation attempts by EMS or private ambulance. There was no significant difference in survival to admission (16.7%; 68/406 and 24.3%; 28/115; p=0.064) and survival to discharge (7.9%; 32/406 and 14.8%; 17/115; p=0.094) between patients who did not receive bystander CPR and patients who did. In contrast, the rate of good neurological function of patients who did not receive bystander CPR (4.7%, 19/406) was significantly lower than that of patients who received bystander CPR (12.2%, 14/115; p=0.004). Moreover, multivariate analysis showed that no bystander CPR (OR: 0.276; 95% CI: 0.124-0.614) was inversely and independently associated with good neurological function. Conclusions: In our study, poor outcomes emphasize the need for increasing bystander CPR performance, increasing the number of EMS ambulances and the utilization of private ambulances, and developing a standard emergency first-aid program for both healthcare personnel and the community.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.148
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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