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BACKGROUND: Acute headache may be the primary symptom of subarachnoid hemorrhage (SAH). Recent guidelines suggest that non-contrast computed tomography (CT) is adequate to exclude aneurysmal SAH if performed within 6 h after symptom onset. However, most studies of acute headache including CT, lumbar puncture and SAH are multicenter studies from referral hospitals with highly selected patient populations. The main purpose of this study was to describe the diagnostic properties of head CT and cerebrospinal fluid (CSF) spectrophotometry for detecting SAH in an unselected primary hospital population with acute headache. METHODS: A retrospective cross-sectional study conducted at a large primary hospital serving roughly 10% of the Norwegian population. Diagnostic workup from consecutive patients evaluated for acute headache in 2009-2020 were collected. All CSF-spectrophotometry reports were standardized and the same CT scanner was used during the study. RESULTS: A total of 3227 patients were included. Median age was 45 years and 63% were women. In total, 170 (5.3% of all acute headache patients) had SAH. Of 3071 CT-negative patients, 2852 (93%) underwent lumbar puncture. Of the CSF reports, 2796 (98%) were negative for xanthochromia. Overall, the rate for detection of aneurysmal SAH by positive xanthochromia was 9 in 2852 cases (3). The miss rate for the detection of an aneurysmal SAH with a CT scan within 6 h was 0 and within 12 h 1 in 2852 cases (0.3). CONCLUSION: In acute headache, a CT scan taken within 6 h is practically 100% sensitive for detecting any SAH.
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Cefaleia , Hemorragia Subaracnóidea , Tomografia Computadorizada por Raios X , Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Hemorragia Subaracnóidea/epidemiologia , Feminino , Masculino , Noruega/epidemiologia , Pessoa de Meia-Idade , Estudos Transversais , Adulto , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Cefaleia/líquido cefalorraquidiano , Cefaleia/etiologia , Estudos Retrospectivos , Idoso , Punção Espinal , Idoso de 80 Anos ou maisRESUMO
OBJECTIVES: The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). MATERIALS & METHODS: All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008-2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. RESULTS: SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. CONCLUSIONS: SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.
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Acidente Vascular Cerebral , Feminino , Hospitalização , Hospitais , Humanos , Incidência , Razão de Chances , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologiaRESUMO
OBJECTIVES: The aim of the present study was to investigate how the initial phase of the COVID-19 pandemic affected the hospital stroke management and research in Norway. MATERIALS AND METHODS: All neurological departments with a Stroke Unit in Norway (n = 17) were invited to participate in a questionnaire survey. The study focused on the first lockdown period, and all questions were thus answered in regard to the period between 12 March and 15 April 2020. RESULTS: The responder rate was 94% (16/17). Eighty-one % (13/16) reported that the pandemic affected their department, and 63% (10/16) changed their stroke care pathways. The number of new acute admissions in terms of both strokes and stroke mimics decreased at all 16 departments. Fewer patients received thrombolysis and endovascular treatment, and multidisciplinary stroke rehabilitation services were less available. The mandatory 3 months of follow-up of stroke patients was postponed at 73% of the hospitals. All departments conducting stroke research reported a stop in ongoing projects. CONCLUSION: In Norway, hospital-based stroke care and research were impacted during the initial phase of the COVID-19 pandemic, with likely repercussions for patient care and outcomes. In the future, stroke departments will require contingency plans in order to protect the entire stroke treatment chain.
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COVID-19/epidemiologia , Controle de Doenças Transmissíveis/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/epidemiologia , Inquéritos e Questionários , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/tendências , Seguimentos , Hospitalização/tendências , Humanos , Noruega/epidemiologia , Pandemias/prevenção & controle , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/tendênciasRESUMO
BACKGROUND: There was a significant decrease in stroke admissions during the first phase of the COVID-19 pandemic. There are concerns that stroke patients have not sought medical attention and in the months after the lockdown suffer recurrent severe strokes. The aims of this study were to investigate how stroke admission rates and distributions of severity varied before, during and after the lockdown in a representative Norwegian hospital population. METHODS: All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke from January to September 2020 were identified by hospital chart review. RESULTS: We observed a transient decrease in weekly stroke admissions during lockdown from an average of 21.4 (SD 4.7) before to 15.0 (SD 4.2) during and 17.2 (SD 3.3) after (p < 0.011). The proportion of mild ischemic and haemorrhagic strokes was also lower during lockdown with 66% before, 57% during and 68% after (p = 0.011). CONCLUSION: The period of COVID-19 lockdown was associated with a temporary reduction in total admissions of strokes. In particular, there were fewer with TIA and mild stroke. Given the need to prevent the worsening of symptoms and risk of recurrence, it is necessary to emphasise the importance to seek medical care even in states of emergency.
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COVID-19 , Hospitalização/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Noruega/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Quarentena , SARS-CoV-2RESUMO
BACKGROUND: General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. METHODS: We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. RESULTS: 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. CONCLUSION: The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.
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Clínicos Gerais , Transtornos da Cefaleia Secundários , Transtornos da Cefaleia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/terapia , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND PURPOSE: There are conflicting figures of the incidence of cerebral venous thrombosis (CVT). The incidence was previously estimated to around 0.5/100 000/y, but more recent studies have suggested 1 to 1.5/100 000/y. The purpose of this study was to explore the incidence and mortality of CVT in a Norwegian population. METHODS: A retrospective cross-sectional hospital population-based study conducted at Akershus University Hospital serving roughly 10% of the total Norwegian population. Patients were identified through chart reviews based on the relevant International Classification of Diseases(Tenth Revision) codes for new CVT cases in a 7-year period between January 1, 2011, and December 31, 2017. Only inhabitants living in the hospital's catchment area were included. RESULTS: Sixty-two patients aged 0 to 80 years were identified and included. The median age was 46 years and 53% were females. The overall incidence of CVT was 1.75 (95% CI, 1.36-2.23) per 100 000/y with no significant sex differences. The incidence for children and adolescents (<18 years, n=9) was lower than for adults (≥18 years, n=53); 1.08 (0.52-1.97) versus 1.96 (1.49-2.55) per 100 000/y per year, with the highest incidence for those >50 years with 2.10 (1.38-3.07)/100 000/y. Headache was the most prevalent symptom, reported in 83%, followed by nausea, motor deficits, and seizures observed in 45%, 32%, and 32% of the patients. Transverse sinuses and the jugular vein were the most frequent sites of thrombosis. In most patients (61%), thrombosis occurred in multiple sinuses/veins. Risk factors were found in 73% of the patients, and most of the patients had a combination of 2 or more risk factors. The 30-day and 1-year mortality rates were 3% and 6%. CONCLUSIONS: The incidence of CVT in this population was higher than previously reported. The mortality rate was similar to previous studies.
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Trombose Intracraniana/epidemiologia , Trombose Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Trombose Intracraniana/mortalidade , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Trombose Venosa/mortalidade , Adulto JovemRESUMO
An amendment to this paper has been published and can be accessed via the original article.
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BACKGROUND: The Covid-19 pandemic is causing changes in delivery of medical care worldwide. It is not known how the management of headache patients was affected by the lockdown during the pandemic. The aim of the present study was to investigate how the initial phase of the Covid-19 pandemic affected the hospital management of headache in Denmark and Norway. METHODS: All neurological departments in Denmark (n = 14) and Norway (n = 18) were invited to a questionnaire survey. The study focused on the lockdown and all questions were answered in regard to the period between March 12th and April 15th, 2020. RESULTS: The responder rate was 91% (29/32). Of the neurological departments 86% changed their headache practice during the lockdown. The most common change was a shift to more telephone consultations (86%). Video consultations were offered by 45%. The number of new headache referrals decreased. Only 36% administered botulinum toxin A treatment according to usual schemes. Sixty% reported that fewer patients were admitted for in-hospital emergency diagnostics and treatment. Among departments conducting headache research 57% had to halt ongoing projects. Overall, 54% reported that the standard of care was worse for headache patients during the pandemic. CONCLUSION: Hospital-based headache care and research was impacted in Denmark and Norway during the initial phase of the Covid-19-pandemic.
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Infecções por Coronavirus , Atenção à Saúde , Transtornos da Cefaleia/terapia , Neurologia , Pandemias , Pneumonia Viral , Telemedicina/estatística & dados numéricos , Betacoronavirus , Toxinas Botulínicas Tipo A/uso terapêutico , COVID-19 , Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/terapia , Dinamarca , Gerenciamento Clínico , Cefaleia/diagnóstico , Cefaleia/terapia , Transtornos da Cefaleia/diagnóstico , Departamentos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Fármacos Neuromusculares/uso terapêutico , Noruega , Ambulatório Hospitalar , Encaminhamento e Consulta , SARS-CoV-2 , Inquéritos e Questionários , Telecomunicações/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricosRESUMO
BACKGROUND: In Norway, as in most other countries, the training program for clinical neurology has no mandatory headache program. Knowledge in headache management must therefore be acquired during everyday clinical training. The objectives of this study were to investigate neurology residents' knowledge of headache. METHODS: A questionnaire survey was undertaken among neurology residents in Norway. RESULTS: All 17 neurological departments in Norway participated, and 143 residents responded (86%). Sixty percent were women, mean age was 32.5 years, and the respondents had an average of 28 months clinical training in neurology. Fifty-six percent knew the approximate prevalence of migraine and chronic headache. Thirty-seven percent asked their patients about disability, quality of life, and social functioning at every consultation. Further, 72% would prescribe prophylaxis for chronic tension-type headache and 97% for very frequent migraine. One third wrongly stated that use of the most common headache prophylactics could lead to medication-overuse headache. Headache diaries were used regularly by 63% for diagnostic purposes, and 73% requested an MRI for all long-lasting headaches referred to neurological outpatient clinics. CONCLUSION: Although a major public health problem, headache knowledge is moderate at best, and its management clearly varies. There is an unmet need for a better and more structured headache training program in Norway.
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Cefaleia , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência , Neurologia/educação , Adulto , Feminino , Humanos , Masculino , Noruega , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Neurology has increasing subspecialization. Some disorders, such as cerebrovascular diseases, dementia and headache, are highly prevalent in the general population, while others, such as movement disorders and multiple sclerosis, are rarer. Thus, there may be a mismatch between neurologists' interests and the population needs. AIMS OF THE STUDY: To investigate the perceived prestige of neurological disorders among residents in neurology. METHODS: The study was conducted as a questionnaire survey among residents in neurology in Norway. RESULTS: All the 17 neurological departments in Norway participated. In total, 143 residents participated (86% response rate). Mean age was 32.5 years. The respondents had on average 28 months of clinical training in neurology. The subspecialty with the highest prestige was cerebrovascular diseases, scored by 62% as the most prestigious, followed by multiple sclerosis (36%) and epilepsy (7%). The subspecialties with the lowest prestige were headache (2.8%) and dementia (1.4%). None of the tested variables (gender, age, months in clinical training or type of hospital) were associated with the perceived prestige of neurological disorders. CONCLUSION: Cerebrovascular disease was perceived as the most prestigious subspecialty. Headache and dementia, which are major contributors to worldwide disability, have low status among residents in neurology.
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Internato e Residência , Avaliação das Necessidades , Doenças do Sistema Nervoso , Neurologistas , Adulto , Feminino , Humanos , Masculino , Neurologia/educação , Noruega , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Emergency department (ED) crowding and prolonged length of stay (LOS) are associated with delays in treatment, adverse outcomes and decreased patient satisfaction. Hospital restructuring and mergers are often associated with increased ED crowding. The aim of this study was to explore ED crowding and LOS in Norway's largest ED before and after an increased catchment area. METHODS: The catchment area of Akershus University Hospital increased by approximately 150,000 inhabitants in 2011, from 340,000 to 490,000. In this retrospective study, admissions to the ED during a six-year period, from Jan 1st 2010 to Dec 31st 2015 were included and analyzed. RESULTS: A total of 179,989 admissions were included (51.0% men). The highest occupancy rate was in the age group 70-79 years. Following the increase in the catchment area, the annual ED admissions increased by 8343 (40.9%) from 2010 to 2011, and peaked in 2013 (34,002). Mean LOS increased from 3:59 h in 2010 to 4:17 in 2012 (highest), and decreased to 3:45 h in 2015 after staff, capacity and organizational measures. In 2010, 37.9% of the ED patients experienced crowding, and this proportion increased to between 52.9-77.6% in 2011-2015. Crowding peaked between 4 and 5 PM. CONCLUSIONS: LOS increased and crowding was more frequent after a major increase in the hospital's catchment area in Norway's largest emergency department. Even after 5 years, the LOS was higher than before the expansion, mainly because of the throughput and output components, which were not properly adapted to the changes in input.
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Área Programática de Saúde , Aglomeração , Serviço Hospitalar de Emergência , Tempo de Internação , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hospitalização , Hospitais Universitários , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Noruega , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Stroke incidence rates have fallen in high-income countries over the last several decades, but findings regarding the trend over recent years have been mixed. The aim of the study was to describe and model temporal trends in incidence of stroke by age and sex between 2010 and 2015 in Norway, and to generate incidence projections towards year 2040. METHODS: All recorded strokes in Norway between 2010 and 2015 were extracted from the National Patient Registry and the National Cause of Death Registry. We report incidence by age, sex, and year; in raw numbers, per 100,000 person-years, by WHO and European standard populations; and generated statistical models by stroke type, age, sex, and year; and projected stroke incidence toward year 2040. RESULTS: The data covered 30.1 million person-years at risk, 53431 unique individuals hospitalized with a primary stroke diagnosis, and 6315 additional individuals registered as dead due to stroke. From 2010 to 2015, individuals suffering stroke per 100,000 person-years dropped from 239 to 195 (208 to 177 excluding immediate deaths). The decline was driven by ischemic strokes, with a statistically non-significant time trend for hemorrhagic stroke. CONCLUSIONS: The age-dependent incidence of ischemic strokes in Norway is declining rapidly, and more than compensates for the growth and ageing of the population. Comparisons with historic incidence statistics show that the reduction in incidence rates has accelerated over the last two decades.
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Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Feminino , Previsões , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Sistema de Registros , Distribuição por SexoRESUMO
AIMS: Awareness of stroke symptoms and risk factors, and actions taken in order to reduce the risk of new stroke events, should be of great importance among stroke survivors. The aims of this study were to assess changes in stroke-related knowledge and lifestyle behavior among patients experiencing a cerebrovascular event, and to assess the agreement between the patients' self-reported diagnosis, and the discharge diagnosis. METHODS: All patients discharged with a diagnosis of stroke or transient ischemic attack during a 1-year period, received postal survey questionnaires at 3 and 12 months after discharge. The questionnaires included questions about symptom knowledge, lifestyle behavior, and patients were asked to report on their diagnosis. RESULTS: A total of 282 patients were included (mean age 71.8 years, 57.1% men). Self-reported symptom knowledge was increased at 3 months (P < .001), and this persisted at 12 months. There was a poor correlation (râ¯=â¯.082; Pâ¯=â¯.171) between increasing symptom knowledge and stated lifestyle behavior changes. In all, 63% of the respondents correctly identified their own cerebrovascular subtype. Thirty-seven percent had quit smoking after 12 months, 30% reported that they used less sugary items, and 26% used less fatty food after the cerebrovascular event. CONCLUSIONS: Stroke survivors reported increased stroke symptoms knowledge after 3 and 12 months. A proportion of patients made changes in lifestyle behavior. Only 2 out of 3 patients correctly identified their own cerebrovascular subtype, indicating room for improvement in clinical practice when informing and communicating with stroke and transient ischemic attack patients about their diagnosis.
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Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Estilo de Vida Saudável , Comportamento de Redução do Risco , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Sobreviventes/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Educação de Pacientes como Assunto , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Autorrelato , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Non-attendance and late arrivals diminish patient flow in outpatient clinics. On the other hand, patient earliness may also be undesirable. Physicians often experience that older patients are more punctual than younger patients, and often they come excessively early. The aim of this study was to determine whether an association between age and outpatient clinic arrival time could be established or not, i.e. to find out if it is a myth or a reality. METHODS: Prospective descriptive study performed at a neurological outpatient clinic. Data were collected from all scheduled appointments during an eight-week period. Variables included were age, gender, appointment time, arrival time, no-shows, appointment type, need for assistance and if it was an early or late appointment. Outcomes were unpunctuality (early and late arrivals) and non-attendance. RESULTS: Of 1353 appointments, non-attendance rate was 9.5 and 5.1% were late arrivals. Median age increased with increased patient earliness (p < 0.001). Younger age (p = 0.007) and new referrals (p = 0.025) were associated with non-attendance. CONCLUSIONS: The intuition of an association between age and outpatient clinic arrival time was confirmed, thus it is a reality that older patients attend their appointments more frequently and have better punctuality than younger adults. This age effect in outpatient clinics should be considered when developing future simulation models and intervention studies.
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Agendamento de Consultas , Ambulatório Hospitalar/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/terapia , Pacientes não Comparecentes/estatística & dados numéricos , Noruega , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de TempoRESUMO
OBJECTIVES: Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades. METHODS: We compared time from symptom onset to admission in 2 cohorts of stroke patients admitted to Akershus University Hospital, Norway, in 1994 (n = 550) and 2012 (n = 522), and constructed predictive models for arrival within 3 hours for each cohort. RESULTS: More patients arrived within 3 hours of symptom onset in 2012 compared to 1994 (proportion, 47.1% versus 19.3%, P < .001), also after adjusting for age, sex, and baseline differences; odds ratio (OR) was 5.14 (95% confidence interval [CI] 3.69-7.15). Stroke severity was the only predictor examined that was independently associated with early arrival during both periods. For patients with moderate strokes the overall OR was 2.06 (95% CI 1.41-3.00) and for severe strokes 4.52 (95% CI 2.97-6.87), compared to those with mild strokes. In the 1994 cohort additional predictors of early arrival were living with others and not being admitted from nursing home. CONCLUSIONS: Prehospital delay in Norway has decreased considerably over the last 2 decades and since the availability of time-critical treatments. However, there is still an urgent need to reduce the number of delayed admissions as a large proportion of patients continue to arrive too late to benefit from these treatments. Patients with severer strokes were predicted to have earlier arrival.
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Acidente Vascular Cerebral/terapia , Tempo para o Tratamento/tendências , Idoso , Feminino , Humanos , Masculino , Razão de Chances , Admissão do Paciente/tendências , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologiaRESUMO
BACKGROUND AND PURPOSE: An increasing proportion of patients presenting with suspected stroke prove to have other conditions, often referred to as stroke mimics. The aim of this study was to present a projection of the number of hospitalized strokes, transient ischemic attacks (TIAs), and stroke mimics in Norway up to the year 2050 based on expected demographic changes, to estimate the burden of stroke mimics in the coming decades. MATERIALS AND METHODS: This prospective study included all admissions to the stroke unit of Akershus University Hospital from March 1, 2012, to February 28, 2013. Relevant resource use was recorded. Based on the age- and sex-specific absolute incidences for the study period, the expected numbers of strokes, TIAs, and stroke mimics in the entire Norwegian population were computed for every fifth year for the period 2020-2050. RESULTS: We included 1881 admissions, of which 38.2% were stroke mimics. With constant age- and sex-dependent incidence rates, we estimated that the number of strokes and stroke mimics will respectively increase by 121.3% and 88.7% (men) and 97.6% and 71.7% (women). For hospital admission levels to stay constant at the 2013 level, an annual reduction of 2.1% and 1.7% (men) and 1.8% and 1.5% (women) must take place for strokes and mimics, respectively. CONCLUSIONS: A significant proportion of stroke unit admissions prove to have other conditions than stroke. With constant age- and sex-dependent incidence rates, the number of stroke mimics admissions will increase substantially over the next decades.
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Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Previsões , Hospitais Universitários , Humanos , Incidência , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Admissão do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Distribuição por Sexo , Acidente Vascular Cerebral/diagnóstico , Fatores de TempoRESUMO
BACKGROUND: Too few patients with acute stroke receive thrombolytic therapy owing to the limited time window for treatment and prehospital delay. The purpose of this study is to describe the prehospital path for patients with acute stroke and, in particular, what distinguishes patients who contact the Emergency Medical Communication Centre (EMCC) from those who contact their general practitioner (GP) or Out-of-hours (OOH) services. MATERIAL AND METHOD: Patients with acute cerebral infarction and intracerebral haemorrhage admitted to the Stroke Unit, Department of Neurology, Akershus University Hospital, were included. Data on the prehospital path (prehospital delay, medical contacts) were collected over the period 15 April 2009 1 April 2010. RESULTS: A total of 299 patients were included in the study. The median age was 75 years and 48.5 % were women. In all, 63.9 % of patients with acute stroke called the EMCC, and 93.7 % of these were taken directly to hospital by ambulance. Of those who called the GP's office or OOH services, 60.7 % were asked to go to the GP's office or OOH services in person. Patients who called and attended the GP's office or OOH services had milder neurological deficits (p < 0.001) and longer patient delay (p = 0.018) than those who called the EMCC. INTERPRETATION: Six out of ten patients who contacted the primary health care services were asked to go to the GP's office/OOH services in person, which resulted in unnecessary delay. The findings from this study may indicate a need for specific training of this group of health care professionals in the prompt handling of patients with possible stroke.
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Serviços Médicos de Emergência , Acidente Vascular Cerebral , Plantão Médico/normas , Plantão Médico/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral , Procedimentos Clínicos , Diagnóstico Tardio , Sistemas de Comunicação entre Serviços de Emergência/normas , Sistemas de Comunicação entre Serviços de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Estudos Observacionais como Assunto , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Terapia TrombolíticaRESUMO
BACKGROUND: A proportion of patients with acute ischemic stroke have elevated cardiac troponin levels and ECG changes suggestive of cardiac injury, but the etiology is unclear. The aims of this study were to assess the frequency of high sensitivity cardiac troponin T (hs-cTnT) elevation, to identify determinants and ECG changes associated with hs-cTnT elevation, to identify patients with myocardial ischemia and to assess the impact of hs-cTnT elevation on in-hospital mortality. METHODS: Patients discharged with a diagnosis of acute ischemic stroke during a 1-year period, were included. Patients diagnosed with acute myocardial infarction (MI) within the last 7 days before admission or during hospitalization were excluded. RESULTS: In all, 156 (54.4%) of 287 patients had elevated hs-cTnT. The factors independently associated with hs-cTnT elevation were age ≥ 76 years (OR 3.71 [95% CI 2.04-6.75]), previous coronary heart disease (CHD) (OR 2.61 [1.23-5.53]), congestive heart failure (OR 4.26 [1.15-15.82]), diabetes mellitus (OR 4.02 [1.50-10.76]) and lower eGFR (OR 0.97 [0.95-0.98]). Of the 182 patients who had two hs-cTnT measurements, 12 (6.6%) had both a rise or fall of hs-cTnT with at least one elevated value, and ECG manifestations of myocardial ischemia, e.g. meeting the criteria of acute MI. Both dynamic relative change (p = 0.026) and absolute change (p = 0.032) in hs-cTnT were significantly associated with higher in-hospital mortality. CONCLUSIONS: Established CHD and cardiovascular risk factors are associated with hs-cTnT elevation. Acute MI is likely underdiagnosed in acute ischemic stroke patients. Dynamic changes in troponin levels seem to be related to poor short-term prognosis.