Find research datasets worth reusing

opencc-by-4.0Dec 2019View details →

Burden of Influenza in Patients visiting Emergency Department for Treatment of Influenza Like Illness at THQ Hospital Shujabad, Pakistan

Supplementary files

opencc-by-4.0Jul 2018View details →

Base de datos: Pérdida de la densidad mineral ósea secundaria al uso de inhibidores de la aromatasa en pacientes con cáncer de mama en el Hospital III EsSalud - Puno, 1997 – 2018

Objetivo: Determinar la relación entre la pérdida de la densidad mineral ósea (BMD) secundaria al uso de inhibidores de la aromatasa en pacientes con cáncer de mama en el hospital III EsSalud - Puno, entre los años 1997 y 2018. Metodología: Nuestro estudio se basó en pacientes diagnosticadas con cáncer de mama en el hospital III EsSalud - Puno, entre los años 1997 y 2018. Separados en 3 grupos: pacientes tratadas con anastrazol; pacientes tratadas con tamoxifeno; y pacientes que recibieron ambos tratamientos. Se recolectaron datos como BMD por DEXA antes y después del tratamiento; duración del tratamiento; estadío del cáncer; edad e IMC al momento del diagnóstico, cuyos resultados fueron evaluados usando estadística descriptiva, análisis de datos en ANOVA y comparación por parejas de Dwass-Steel-Critchlow-Fligner. Resultado: En la población de pacientes (N = 13; edad media, 47.6; duración media del tratamiento, 2.38 años); 38.5 % recibió terapia con anastrazol; 46.2 %, con tamoxifeno; y 15.4 %, ambos fármacos. Hubo diferencias significativas entre el tipo de tratamiento mama (p = 0.011). No se encontró diferencia significativa con respecto a la duración del tratamiento (p=0.135), ni con respecto a la administración de ambos fármacos (p = 0.287). El 80 % del grupo que recibió anastrazol (todos con BMD normal) tuvo un efecto negativo en su BMD que se reflejó en el cambio de categoría a osteopenia. El 100 % del grupo que recibió tamoxifeno no sufrió cambios negativos. Conclusión: Confirmamos que hay una diferencia significativa en la pérdida de BMD después del tratamiento iniciado con anastrazol en los pacientes con cáncer de mama en el hospital III EsSalud - Puno, 1997 – 2018.

Data from: Factors related to time of stroke onset versus time of hospital arrival: A SITS registry-based study in an Egyptian Stroke Center

Background: high-quality data on time of stroke onset and time of hospital arrival is required for proper evaluation of points of delay that might hinder access to medical care after the onset of stroke symptoms. Purpose: Based on (SITS Dataset) in Egyptian stroke patients, we aimed to explore factors related to time of onset versus time of hospital arrival for acute ischemic stroke (AIS). Material and Methods: We included 1,450 AIS patients from two stroke centers of Ain Shams University, Cairo, Egypt. We divided the day to four quarters and evaluated relationship between different factors and time of stroke onset and time of hospital arrival. The factors included: age, sex, duration from stroke onset to hospital arrival, type of management, type of stroke (TOAST classification), National Institute of Health Stroke Scale (NIHSS) on admission and favorable outcome modified Rankin Scale (mRS ≤2). Results: Pre-hospital: highest stroke incidence was in the first and fourth quarters. There was no significant difference in the mean age, sex, type of stroke in relation to time of onset. NIHSS was significantly less in onset in third quarter of the day. Percentage of patients who received thrombolytic therapy was higher with onset in the first 2 quarters of the day (p=<0.001). In-hospital: there was no difference in percentage of patients who received thrombolytic therapy nor in outcome across 4 quarters of arrival to hospital. Conclusion: pre-hospital factors still need adjustment to improve percentage of thrombolysis, while in-hospital factors showed consistent performance.

Serum 25(OH)D level on hospital admission is correlated with COVID-19 mortality

Objective: Vitamin D deficiency was previously correlated with incidence and severity of COVID-19. We investigated the correlation between serum 25(OH)D level on admission and radiological stage and outcome of COVID-19 pneumonia. Methods: Retrospective observational trial on 186 SARS-CoV-2-infected individuals hospitalized from March 1, 2020 to April 7, 2020 with combined chest CT and 25(OH)D measurement on admission. Multivariate analysis was performed to study if vitamin D deficiency (25(OH)D < 20 ng/mL) predicts survival independently of confounding comorbidities. Results: 59% of COVID-19 patients were vitamin D deficient on admission: 47% of females and 67% of males. Particularly male COVID-19 patients showed progressively lower 25(OH)D with advancing radiological stage, with deficiency rates increasing from 55% in stage 1 to 74% in stage 3. Vitamin D deficiency on admission was not confounded by age, chronic lung disease, coronary artery disease/hypertension or diabetes and was correlated with mortality (OR=3.87, 95%CI 1.30-11.55), independently of other predictors including age (OR=1.09, 95%CI 1.03-1.14), chronic lung disease (OR=3.61, 95% CI 1.18-11.09) and extent of lung damage expressed by chest CT severity score (1.12, 95% CI 1.01-1.25). Conclusions: low 25(OH)D levels on admission are associated with COVID-19 disease mortality

Data from: Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal

Objectives: Scrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur, Nepal. Study design and setting: This was a hospital laboratory based prospective study conducted in CMC-TH (a 600-bed hospital) located in Bharatpur, Chitwan district of Nepal. Participants: A total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 380C) were enrolled in this study. Methods: A total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by Enzyme Linked Immunosorbent Assay (ELISA) for specific immunoglobulin M (IgM) antibody and Weil-Felix test. Results: Out of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district 271 (51.7%) with predominance among females 314 (35.9%). Scrub typhus was common among age group 51-60 years (37.2%) and farmers 182 (37.8%). Highest seropositivity was found in July 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase AST 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r = 0.319, p<0.001). Conclusion: High prevalence of scrub typhus implies that acute febrile patients should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all level of health care system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programs need to be promoted for early diagnosis, treatment and control.

Rates of rehospitalisation in the first two years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam – A follow-up study

Objectives To describe the characteristics of rehospitalisation in Vietnamese preterm infants, and to examine the time-to-first-readmission between two gestational age (GA) groups (extremely/very preterm, EVP, versus moderate/late preterm, MLP). Further, to compare rehospitalisation rates according to GA and corrected age (CA), and to examine the association between potential risk factors and rehospitalisation rates. Design and Setting Cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam. Participants All preterm newborns admitted to the NICU from July 2013 to September 2014. Main outcomes Rates, durations and causes of hospital admission during the first two years. Results Of 294 preterm infants admitted to NICU (all out-born, GA ranged from 26 to 36 weeks), 255 were discharged alive, and 211 (83%) NICU graduates were followed up at least once during the first two years CA, of whom 56% was hospital readmitted. Median (interquartile range) of hospital stay was 7 (6 to 10) days. Respiratory diseases were the major cause (70%). Compared with MLP infants, EVP infants had a higher risk of first rehospitalisation within the first 6 months of age (p = 0.01). However, the difference in risk declined thereafter and was similar from 20 months of age. There was an interaction in rehospitalisation rates between GA and CA. Longer duration of neonatal respiratory support and having older sibling were associated with higher rehospitalisation rates. Lower rates of rehospitalisation were seen in infants with higher cognitive and motor scores (not statistically significant in cognitive scores). Conclusions Hospital readmission of Vietnamese preterm infants discharged from NICU was frequent during their first two years, mainly due to respiratory diseases. Scale-up of follow-up programmes for preterm infants are needed in LMICs and attempts to prevent respiratory diseases should be considered.

opencc-by-4.0Aug 2020View details →

Dataset for the manuscript titled "Assessment of Anti-Tuberculosis Medication Adherence and Associated Factors among Patients attending the Sokoto Specialist Hospital Tuberculosis Treatment Center, Nigeria – 2019".

Dataset of the research entitled "Assessment of Anti-Tuberculosis Medication Adherence and Associated Factors among Patients attending the Sokoto Specialist Hospital Tuberculosis Treatment Center, Nigeria – 2019".

opencc-zeroOct 2020View details →

Knowledge and use of complementary therapies in a tertiary care hospital in France: a preliminary study

Purpose: Few studies have clarified the use of complementary therapies (CTs) in France. The main objective of this preliminary study was to evaluate knowledge of CTs in four representative groups of patients: patients suffering from cancer, patients presenting with a chronic noncancerous disease, chronic dialysis patients and nonchronic or cancerous patients needing surgery. Methods: A formalized questionnaire was designed by two psychologists, an oncologist and an anesthesiologist in charge of the Pain Clinic and Support Care Unit. One hundred eleven patients were enrolled, and all agreed to complete the questionnaire. Results: Eighty (72%) patients did not know the term "complementary therapies" (patients who were "not aware of CTs"), and 24 (21.6%) patients knew the term "complementary therapies" (patients who were "aware of CTs"), while seven patients were not sure of the meaning. There were no differences between aware and unaware patients in gender (p=0.27), age (p=0.24), level of education (p=0.24) or professional occupation (p=0.06). Knowledge about CTs was significantly different among the different categories of patients (p=0.03), with the only statistically significant difference between groups being between oncologic patients receiving ambulatory chemotherapy and patients presenting with a chronic noncancerous disease (p=0.004). Conclusion: This preliminary study clearly highlights that patients and health caregivers are not aware of CTs and that there is a need for better communication about CTs.

opencc-zeroJan 2021View details →

Data from: Vitamin D status and COVID-19 clinical outcomes in hospitalized patients

Context: Populations severely affected by COVID-19 are also at risk for vitamin D deficiency. Common risk factors include older age, chronic illness, obesity, and non-Caucasian race. Vitamin D deficiency has been associated with risk for respiratory infections and failure, susceptibility and response to therapy for enveloped virus infection, and immune-mediated inflammatory reaction. Objective: To test the hypothesis that 25-hydroxyvitamin D[25(OH)D] deficiency is a risk factor for severity of COVID-19 respiratory and inflammatory complications. Design: We examined the relationship between retrospectively obtained prehospitalization 25(OH)D levels and COVID-19 clinical outcomes in 700 COVID-19 positive hospitalized patients. Primary Outcomes: Discharge status, mortality, length of stay, intubation status, renal replacement Secondary Outcomes: Inflammatory markers Results: 25(OH)D levels were available in 93 patients [25(OH)D:25(IQR:17–33)ng/mL]. Compared to those without 25(OH)D levels, those with measurements did not differ in age, BMI or distribution of sex and race, but were more likely to have comorbidities. Those with 25(OH)D<20ng/mL (n=35) did not differ from those with 25(OH)D³20ng/mL in terms of age, sex, race, BMI, or comorbidities. Low 25(OH)D tended to be associated with younger age and lower frequency of preexisting pulmonary disease. There were no significant between-group differences in any outcome. Results were similar in those ³50years, in male/female-only cohorts, and when differing 25(OH)D thresholds were used (<15ng/ml and <30ng/ml). There was no relationship between 25(OH)D as a continuous variable and any outcome, even after controlling for age and pulmonary disease. Conclusions: These preliminary data do not support a relationship between vitamin D status and COVID-19 clinical outcomes.

opencc-zeroJan 2021View details →

Incidents of aggression in German psychiatric hospitals: Is there an increase?

Introduction: In a meta-analysis of international studies, 17% of admitted patients in psychiatric hospitals had shown violent behaviour towards others. Reported data from studies in Germany were considerably lower until now. However, studies referred to single hospitals and data quality was questionable. It is under discussion whether there is an increase of violent incidents. Methods: In a group of 10 hospitals serving about half of the population of the Federal State of Baden-Wuerttemberg with 11 million inhabitants, the staff observation aggression scale, revised (SOAS-R) was introduced into the electronic charts as part of routine documentation. Data recording was strongly supported by staff councils and unions. Complete data is now available for the year 2019. For one hospital, data is available since 2006. Due to some doubts with respect to fully covering self-directed aggression, we restricted the analysis to aggression toward others and toward objects. Results: In 2019, 17,599 aggressive incidents were recorded in 64,367 admissions (1,660 staying forensic psychiatric patients included). 5,084 (7.90%) of the admitted cases showed aggressive behaviour towards others. Variation between hospitals was low to modest (SD=1.50). The mean SOAS-R score was 11.8 (SD between hospitals 1.20 %). 23% of the incidents resulted in bodily harm. The percentage of patients with violent behaviour was highest among patients with organic disorders (ICD-10 F0) and lowest among patients with addictive or affective disorders (F1, F3, F4). Forensic psychiatry had the highest proportion of cases with aggressive behaviour (20.54 %), but the number of incidents per bed was lower than in general adult psychiatry and child and adolescent psychiatry, indicating a lower risk for staff. In the hospital with long-time recordings available, an increase could be observed since 2010, with considerable variation between years. Conclusion: This is the most robust estimate of the frequency of violent incidents in German psychiatric hospitals so far. The incidence is about half of what has been reported internationally, probably due to sample selection bias in previous studies and a relatively high number of hospital beds in Germany. Available data suggests an increase in violent incidents over the last ten years; however, it is unclear to what extent this is due to increased reporting.

opencc-zeroDec 2017View details →

Data from: Multi-perspective predictive modeling for acute kidney injury in general hospital populations using electronic medical records

Objective: Acute kidney injury (AKI) in hospitalized patients puts them at much higher risk for developing future health problems such as chronic kidney disease, stroke, and heart disease. Accurate AKI prediction would allow timely prevention and intervention. However, current AKI prediction researches pay less attention to model building strategies that meet complex clinical application scenario. This study aims to build and evaluate AKI prediction models from multiple perspectives that reflect different clinical applications. Material and Methods: A retrospective cohort of 76,957 encounters and relevant clinical variables were extracted from a tertiary care, academic hospital electronic medical record (EMR) system between November 2007 and December 2016. Five machine learning methods were used to build prediction models. Prediction tasks from four clinical perspectives with different modeling and evaluation strategies were designed to build and evaluate the models. Results: Experimental analysis of the AKI prediction models built from four different clinical perspectives suggest a realistic prediction performance in cross-validated AUC ranging from 0.720 to 0.764. Discussion: Results show that models built at admission is effective for predicting AKI events in the next day; models built using data with a fixed lead time to AKI onset is still effective in the dynamic clinical application scenario in which each patient's lead time to AKI onset is different. Conclusion: To our best knowledge, this is the first systematic study to explore multiple clinical perspectives in building predictive models for AKI in the general inpatient population to reflect real performance in clinical application.

opencc-zeroDec 2016View details →

Data from: Effect of HIV and malaria parasites co-infection on immune-hematological profiles among patients attending anti-retroviral treatment (ART) clinic in Infectious Disease Hospital Kano, Nigeria

Background Human immunodeficiency virus (HIV) and malaria co-infection may present worse health outcomes in the tropics. Information on HIV/malaria co-infection effect on immune-hematological profiles is critical for patient care and there is a paucity of such data in Nigeria. Objective To evaluate immune-hematological profiles among HIV infected patients compared to HIV/malaria co-infected for ART management improvement. Methods This was a cross sectional study conducted at Infectious Disease Hospital, Kano. A total of 761 consenting adults attending ART clinic were randomly selected and recruited between June and December 2015. Participants' characteristics and clinical details including two previous CD4 counts were collected. Venous blood sample (4ml) was collected in EDTA tube for malaria parasite diagnosis by rapid test and confirmed with microscopy. Hematological profiles were analyzed by Sysmex XP-300 and CD4 count by Cyflow cytometry. Data was analyzed with SPSS 22.0 using Chi-Square test for association between HIV/malaria parasites co-infection with age groups, gender, ART, cotrimoxazole and usage of treated bed nets. Mean hematological profiles by HIV/malaria co-infection and HIV only were compared using independent t-test and mean CD4 count tested by mixed design repeated measures ANOVA. Statistical significant difference at probability of <0.05 was considered for all variables. Results Of the 761 HIV infected, 64% were females, with a mean age of ± (SD) 37.30 (10.4) years. Prevalence of HIV/malaria co-infection was 27.7% with Plasmodium falciparum specie accounting for 99.1%. No statistical significant difference was observed between HIV/malaria co-infection in association to age (p = 0.498) and gender (p = 0.789). A significantly (p = 0.026) higher prevalence (35.2%) of co-infection was observed among non-ART patients compared to (26%) ART patients. Prevalence of co-infection was significantly lower (20.0%) among cotrimoxazole users compared to those not on cotrimoxazole (37%). The same significantly lower co-infection prevalence (22.5%) was observed among treated bed net users compared to those not using treated bed nets (42.9%) (p = 0.001). Out of 16 hematology profiles evaluated, six showed significant difference between the two groups (i) packed cell volume (p = <0.001), (ii) mean cell volume (p = 0.005), (iii) mean cell hemoglobin concentration (p = 0.011), (iv) absolute lymphocyte count (p = 0.022), (v) neutrophil percentage count (p = 0.020) and (vi) platelets distribution width (p = <0.001). Current mean CD4 count cell/μl (349±12) was significantly higher in HIV infected only compared to co-infected (306±17), (p = 0.035). A significantly lower mean CD4 count (234.6 ± 6.9) was observed among respondents on ART compared to non-ART (372.5 ± 13.2), p<0.001, mean difference = -137.9). Conclusion The study revealed a high burden of HIV and malaria co-infection among the studied population. Co-infection was significantly lower among patients who use treated bed nets as well as cotrimoxazole chemotherapy and ART. Six hematological indices differed significantly between the two groups. Malaria and HIV co-infection significantly reduces CD4 count. In general, to achieve better management of all HIV patients in this setting, diagnosing malaria, prompt antiretroviral therapy, monitoring CD4 and some hematology indices on regular basis is critical.

opencc-zeroDec 2017View details →

Data from: Comparison of the validity of the checklist assessment in the cardiac arrest simulations with the app in an academic hospital in Taiwan: a retrospective observational study

Background: Robust assessment is a crucial component in Advanced Cardiac Life Support (ACLS) training to determine whether participants have achieved learning objectives with little or no variation in their overall outcomes. This study aimed to evaluate resuscitation performance by real-time logs. We hypothesized that instructors may not be able to evaluate time-sensitive parameters, namely, chest compression fraction, time to initiating chest compression, and time to initiating defibrillation efficiently in a subjective manner. Methods: Video records and formal checklist-based test results of Megacode scenarios for the ACLS certification examination at several hospitals in Taipei were examined. For the study interest, three time-sensitive parameters were measured via video review assisted by a mobile phone application, and were used for evaluation. We evaluated if the pass/fail results made by instructors via checklists were correlated with these parameters. Results: A total of 185 Megacode scenarios were eligible for the final analysis. Among the three parameters, good chest compression fraction was statistically significant with higher odds ratio (OR) of passing (OR = 3.65; 95% confidence interval [CI]: 1.36-9.91; P = 0.01). In 112 participants with one parameter that did not meet the criteria, 25 were graded as fail, making the specificity 22.3% (95% CI: 15.0-31.2%). Conclusions: Visual observation of cardiopulmonary resuscitation performance is not accurate when evaluating time-sensitive parameters. Objective results should be offered for training outcome evaluation, and also for feedback to participants.

opencc-zeroDec 2014View details →

Data from: Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in-situ simulation

Objectives: To incorporate behavioural insights into the user-centred design of an inpatient prescription chart (Imperial Drug Chart Evaluation and Adoption Study, IDEAS chart) and to determine whether changes in the content and design of prescription charts could influence prescribing behaviour and reduce prescribing errors. Design: A mixed-methods approach was taken in the development phase of the project; in situ simulation was used to evaluate the effectiveness of the newly developed IDEAS prescription chart. Setting: A London teaching hospital. Interventions/methods: A multimodal approach comprising (1) an exploratory phase consisting of chart reviews, focus groups and user insight gathering (2) the iterative design of the IDEAS prescription chart and finally (3) testing of final chart with prescribers using in situ simulation. Results: Substantial variation was seen between existing inpatient prescription charts used across 15 different UK hospitals. Review of 40 completed prescription charts from one hospital demonstrated a number of frequent prescribing errors including illegibility, and difficulty in identifying prescribers. Insights from focus groups and direct observations were translated into the design of IDEAS chart. In situ simulation testing revealed significant improvements in prescribing on the IDEAS chart compared with the prescription chart currently in use in the study hospital. Medication orders on the IDEAS chart were significantly more likely to include correct dose entries (164/164 vs 166/174; p=0.0046) as well as prescriber's printed name (163/164 vs 0/174; p<0.0001) and contact number (137/164 vs 55/174; p<0.0001). Antiinfective indication (28/28 vs 17/29; p<0.0001) and duration (26/28 vs 15/29; p<0.0001) were more likely to be completed using the IDEAS chart. Conclusions: In a simulated context, the IDEAS prescription chart significantly reduced a number of common prescribing errors including dosing errors and illegibility. Positive behavioural change was seen without prior education or support, suggesting that some common prescription writing errors are potentially rectifiable simply through changes in the content and design of prescription charts.

opencc-zeroDec 2014View details →

Data from: Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital

Background: Controversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI). According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting. Objectives: The aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES) patients and to compare the clinical and anthropometric characteristics and length of stays (LOS) between obese and non-obese patients and between patients with and without NI. Methods: We conducted a cross-sectional study with a sample (n = 82) adult ES patients (21–59 years old) who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test), and the association between preoperative risk-factors and NI was evaluated using odds ratios. Results: The distribution of subjects by NS category was: underweight (3.66%), normal-weight (28.05%), overweight (35.36%), and obese (32.93%). The prevalence of NI was 14.63%. The LOS was longer (p<0.001) for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients. Conclusion: The prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

opencc-zeroDec 2018View details →

Data from: Lower carotid revascularization rates after stroke in ethnic minority-serving US hospitals

Objective: We sought to determine whether the use of carotid revascularization procedures after stroke due to carotid stenosis differs between minority-serving hospitals and hospitals serving predominantly white patients. Methods: We identified ischemic stroke cases due to carotid disease, identified by ICD9-CM codes, from 2007-2011 in the Nationwide Inpatient Sample. The use of carotid endarterectomy (CEA) and carotid artery stenting (CAS) was recorded. Hospitals with ≥40% ethnic minority patients (minority-serving hospitals) were compared to hospitals with <40% minority patients (white hospitals). Logistic regression was used to evaluate the use of CEA/CAS among minority-serving and white hospitals. Results: Of the 26,189 ischemic stroke cases meeting inclusion criteria, 20,870 (79.7%) were treated at 1,113 white hospitals, and 5,319 (20.3%) received care at 325 hospitals minority-serving hospitals. Compared to patients in white hospitals, patients in minority hospitals were less likely to undergo CEA/CAS (17.6%, 95% CI 16.6%-18.6%, in minority vs. 21.2%, 95% CI 20.7%-21.8%, in white hospitals, p<0.001). In fully adjusted logistic regression models, the odds of CEA/CAS were lower in minority compared to white hospitals (OR 0.81, 95% CI 0.70-0.93), independent of individual patient race and other measured hospital characteristics. Whites and Hispanics had significantly lower odds of CEA/CAS in minority compared to white hospitals. Patient-level racial differences in the use of carotid revascularization procedures remained within each hospital stratum. Conclusions: The odds of carotid revascularization after stroke is lower in minority-serving compared to white hospitals, suggesting system-level factors as a major contributor to explain race disparities in the use of carotid revascularization.

opencc-zeroAug 2019View details →

Data from: Hospital distance, socioeconomic status, and timely treatment of ischemic stroke

Objective: To determine whether lower socioeconomic status (SES) and longer home-hospital driving time are associated with reductions in tPA administration and timeliness of the treatment. Methods: We conducted a retrospective observational study using data from the Get With The Guidelines-Stroke Registry (GWTG-Stroke) between January 2015 to March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by EMS to one of 1,489 US hospitals. We defined each patient's SES based on their zip code median household income. We calculated the driving time between each patient's home zip code and the hospital where they were treated, using the Google Maps Directions Application Programing Interface. The primary outcomes were tPA administration and onset-to-arrival time (OTA). Outcomes were analyzed using hierarchical multivariable logistic regression models. Results: SES was not associated with OTA (p=0.31) or tPA administration (p=0.47), but was associated with the secondary outcomes of onset-to-treatment time (p=0.0160) and in-hospital mortality (p=0.0037), with higher SES associated with shorter OTT and lower in-hospital mortality. Driving time was associated with tPA administration (p <0.001) and OTA (p <0.0001), with lower odds of tPA (0.83, 0.79-0.88) and longer OTA (1.30, 1.24-1.35) in patients with the longest versus shortest driving time quartiles. Lower SES quintiles were associated with slightly longer driving time quartiles (p=0.0029), but there was no interaction between the SES and driving time for either OTA (p=0.1145) or tPA (p=0.6103). Conclusions: Longer driving times were associated with lower odds of tPA administration and longer OTA, however SES did not modify these associations.