ABSTRACT
BACKGROUND: Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. METHODS: We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. RESULTS: Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]). CONCLUSIONS: Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.
Subject(s)
Cerebral Angiography/methods , Computed Tomography Angiography , Delayed Diagnosis , Stroke/diagnostic imaging , Stroke/mortality , Age Factors , Aged , Aged, 80 and over , England , Female , Hospital Mortality , Humans , Male , Middle Aged , Odds Ratio , Predictive Value of Tests , Prognosis , Prospective Studies , Registries , Risk Assessment , Risk Factors , Stroke/therapy , Time Factors , Time-to-TreatmentABSTRACT
BACKGROUND AND PURPOSE: An accurate prognosis is useful for patients, family, and service providers after acute stroke. METHODS: We validated the Stroke subtype, Oxfordshire Community Stroke Project Classification, Age, and prestroke Rankin stroke score in predicting inpatient and 7-day mortality using data from 8 National Health Service hospital trusts in the Anglia Stroke and Heart Clinical Network between September 2008 and April 2011. RESULTS: A total of 3547 stroke patients (ischemic, 92%) were included. An incremental increase of inpatient and 7-day mortality was observed with increase in Stroke subtype, Oxfordshire Community Stroke Project Classification, Age, and prestroke Rankin stroke score. Using a cut-off of ≥3, the area under the receiver operator curves values for inpatient and 7-day mortality were 0.80 and 0.82, respectively. CONCLUSIONS: A simple score based on 4 easily obtainable variables at the point of care may potentially help predict early stroke mortality.