Social History Matters–The Impact of Illicit Drug Use on tPA Use and In-Hospital Mortality in Acute Ischemic Stroke
Journal Title: International Neuropsychiatric Disease Journal - Year 2014, Vol 2, Issue 3
Abstract
Aims: The objective of this descriptive study was to compare time to medical evaluation, intravenous tissue plasminogen activator (IV tPA) use, and short-term outcomes in illicit drug users compared to non-users presenting with acute ischemic stroke (AIS). Study Design: This is a retrospective study performed from our stroke registry using de-identified patient information. Place and Duration of Study: Tulane Medical Center Primary Stroke Center (PSC). Consecutive AIS patients presenting to our PSC from July 2008 to December of 2010 were identified from our prospectively collected stroke registry. Methodology: Patients were categorized as toxicology positive (TP) or toxicology negative (TN). We compared baseline characteristics, clinical presentation, tPA use, and short-term outcomes in TP and TN patients. Results: Two hundred and sixty-three patients met inclusion criteria (median age 63, 35.4% female, 66.5% Black). Nearly 40% of toxicology screens were positive. Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; however, a higher proportion of TN patients were treated with IV tPA (32.1% vs. 21.2%). After adjustment for time from last seen normal to emergency department arrival (LSN-to-ED arrival), the odds of being treated with tPA for TP patients were similar to TN patients (OR 0.69, 95% CI 0.36-1.31, p=0.255). After adjustment for age, NIHSS, glucose, and tPA, the odds of in-hospital mortality in TP patients was 3 times that of TN patients (OR 3.17, 95% CI 1.07-9.43, p=0.038). Conclusion: We found that the disparities observed in tPA use were attenuated after adjustment for time from LSN-to-ED arrival, suggesting an area for future intervention. Additionally, we found that TP patients may be at higher risk for in-hospital mortality. Further study on the role of substance abuse in time to ED arrival, tPA use, and outcome in AIS patients is warranted.
Authors and Affiliations
Sheryl Martin-Schild, Matthew H. M. Marx, Karen C. Albright, Amir Shaban, Amelia K. Boehme, T. Mark Beasley
Keywords
Related Articles
- EP ID EP241490
- DOI 10.9734/INDJ/2014/7708
- Views 144
- Downloads 0
The Impact of Breast Cancer on the Emotional Component of Health
Aim: The aim of this study was to examine how the breast cancer affects the quality of life of women, especially in the emotional component of health compared to women without this disease in our community. Study Design:...
The Development of Cannabidiol as a Psychiatric Therapeutic: A Review of Its Antipsychotic Efficacy and Possible Underlying Pharmacodynamic Mechanisms
Cannabidiol (CBD), a once-considered inert cannabis constituent, is one of two primary constituents of cannabis, alongside delta-9-tetrahydrocannabinol (∆9-THC/THC). In the last 30 years, CBD has become implicated with a...
Quality of Life of Palestine Children Exposed to Wars in Gaza
Aim: This study aimed to investigate the impact of trauma due to wars on quality of life of Palestine children living in Gaza with special reference to 2009 war. It is analytic study; the study sample consisted of 195 ch...
Association of Waist Circumference, Body Mass Index and Height with Depressive Symptoms in Adult Women
Aims: Recent evidences suggest that individuals’ body composition can related to depression symptoms. We aimed to examine the relationship between depressive symptoms and waist circumference (WC), body mass index (BMI) a...
Black Holes in Brain- Is There Any Relationship between Carotid Artery Plaque Type and Cerebral Micro Bleed? - Cohort from Pakistan
Purpose of Study: The purpose of this study is to correlate the presence of chronic micro bleed, patient symptoms, number of chronic micro bleeds and carotid plaque characteristics. Materials and Methods: Seventy consecu...