2017
Characterizing New England Emergency Departments by Telemedicine Use
Zachrison K, Hayden E, Schwamm L, Espinola J, Sullivan A, Boggs K, Raja A, Camargo C. Characterizing New England Emergency Departments by Telemedicine Use. Western Journal Of Emergency Medicine 2017, 18: 1055-1060. PMID: 29085537, PMCID: PMC5654874, DOI: 10.5811/westjem.2017.8.34880.Peer-Reviewed Original ResearchConceptsNew England Emergency DepartmentsRural emergency departmentsEmergency departmentTelemedicine useED characteristicsLow-volume emergency departmentsMultivariable logistic regressionConsultant availabilityIndependent predictorsMultivariable analysisPatient careLogistic regressionPlastic surgeryClinical applicationDescriptive statisticsTelemedicineEngland surveyPrimary objectiveAnnual volumeDepartmentNew England statesPsychiatrySurgeryPediatricsStrokeMultiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy
Nael K, Knitter J, Jahan R, Gornbein J, Ajani Z, Feng L, Meyer B, Schwamm L, Yoo A, Marshall R, Meyers P, Yavagal D, Wintermark M, Liebeskind D, Guzy J, Starkman S, Saver J, Kidwell C. Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy. Stroke 2017, 48: 664-670. PMID: 28138001, PMCID: PMC5325250, DOI: 10.1161/strokeaha.116.014343.Peer-Reviewed Original ResearchConceptsCerebral blood volumeAcute ischemic strokeParenchymal hemorrhageReperfusion therapyIschemic strokeReceiver-operating characteristic curve analysisApparent diffusion coefficientMultiparametric magnetic resonance imagingPretreatment magnetic resonanceMagnetic resonance perfusionValues of CBVCharacteristic curve analysisApparent diffusion coefficient (ADC) valuesMagnetic resonance imagingIndependent predictorsIschemic coreRisk stratificationUnivariate analysisClinical trialsMicrovascular permeabilityBlood volumeInfarction corePatientsResonance imagingDiagnostic accuracy
2014
Reducing Door‐to‐Puncture Times for Intra‐Arterial Stroke Therapy: A Pilot Quality Improvement Project
Mehta B, Leslie‐Mazwi T, Chandra R, Bell D, Sun C, Hirsch J, Rabinov J, Rost N, Schwamm L, Goldstein J, Levine W, Gupta R, Yoo A. Reducing Door‐to‐Puncture Times for Intra‐Arterial Stroke Therapy: A Pilot Quality Improvement Project. Journal Of The American Heart Association 2014, 3: e000963. PMID: 25389281, PMCID: PMC4338685, DOI: 10.1161/jaha.114.000963.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnesthesia Department, HospitalCooperative BehaviorFemaleFibrinolytic AgentsHumansInfusions, Intra-ArterialInterdisciplinary CommunicationMaleMiddle AgedPatient Care TeamPilot ProjectsProcess Assessment, Health CareProgram EvaluationPuncturesQuality ImprovementQuality Indicators, Health CareRetrospective StudiesStrokeThrombectomyThrombolytic TherapyTime and Motion StudiesTime FactorsTime-to-TreatmentTreatment OutcomeWorkflowConceptsPilot quality improvement projectQuality improvement projectPuncture timeMedian doorStroke patientsAnterior circulation stroke patientsIntra-arterial stroke therapyHospital time delayPre-QI cohortCompletion of imagingImprovement projectGreater delayNeurointerventional suiteHospital delayProximal occlusionIndependent predictorsStroke therapyPatient evaluationQI measuresWorse outcomesTherapy leadTreatment decisionsAnesthesia teamPatient arrivalPatientsDeterminants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion
LaBuzetta J, Yoo A, Ali S, Fitzpatrick K, Leslie-Mazwi T, Hirsch J, Schwamm L, Rost N. Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion. Journal Of Stroke And Cerebrovascular Diseases 2014, 23: 2527-2532. PMID: 25238927, PMCID: PMC4256100, DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.020.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overArterial Occlusive DiseasesBrain IschemiaCombined Modality TherapyEndovascular ProceduresFemaleFibrinolytic AgentsHumansInjections, Intra-ArterialLogistic ModelsMaleMiddle AgedPatient DischargeProspective StudiesRegional Blood FlowStrokeStroke RehabilitationTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntra-arterial therapyProximal artery occlusionArtery occlusionIndependent predictorsAIS patientsPoststroke outcomesFavorable outcomeAcute ischemic stroke patientsIntravenous tissue plasminogen activatorInstitutional stroke databaseAcute ischemic strokeIschemic stroke patientsOnly independent predictorTissue plasminogen activatorEligible patientsHospital mortalityTPA administrationIschemic strokeStroke databaseAtrial fibrillationEarly outcomesPrespecified protocolStroke patientsPatient subgroupsUnfavorable outcome
2013
A Risk Score for In‐Hospital Death in Patients Admitted With Ischemic or Hemorrhagic Stroke
Smith E, Shobha N, Dai D, Olson D, Reeves M, Saver J, Hernandez A, Peterson E, Fonarow G, Schwamm L. A Risk Score for In‐Hospital Death in Patients Admitted With Ischemic or Hemorrhagic Stroke. Journal Of The American Heart Association 2013, 2: e005207. PMID: 23525444, PMCID: PMC3603253, DOI: 10.1161/jaha.112.005207.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCerebral HemorrhageChi-Square DistributionDecision Support TechniquesFemaleHospital MortalityHumansInpatientsLogistic ModelsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsRegistriesReproducibility of ResultsRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeSubarachnoid HemorrhageUnited StatesConceptsStroke typeIschemic strokeIntracerebral hemorrhageRisk scoreGuidelines-Stroke databaseHealth Stroke ScaleIn-Hospital DeathRisk of deathHospital mortalityHospital deathStroke ScaleStroke admissionsIndependent predictorsHemorrhagic strokeStroke patientsC-statisticSingle risk scoreOverall populationLogistic regressionPatientsValidation sampleMortalityDeathPoint scorePrediction score
2012
Assessing variability in neurointerventional practice patterns for acute ischemic stroke
Mehta B, Leslie-Mazwi T, Chandra R, Chaudhry Z, Rabinov J, Hirsch J, Schwamm L, Rost N, Yoo A. Assessing variability in neurointerventional practice patterns for acute ischemic stroke. Journal Of NeuroInterventional Surgery 2012, 5: i52. PMID: 23235960, DOI: 10.1136/neurintsurg-2012-010565.Peer-Reviewed Original ResearchConceptsIntra-arterial therapyPractice patternsHealth Stroke Scale scoreIntravenous tissue plasminogen activatorReal-world practice patternsEvidence-based practice guidelinesComprehensive stroke servicesPosterior circulation strokeStroke Scale scoreAcute ischemic strokeAnterior circulation strokeFirst-line therapyLarge vessel occlusionMedian annual volumeTissue plasminogen activatorAcute strokeIschemic strokeIndependent predictorsSymptom onsetConscious sedationStroke servicesTreatment indicationsVessel occlusionTreatment strategiesPractice guidelinesImplementation of a patient selection protocol for intra-arterial therapy increases treatment rates in patients with acute ischemic stroke
Rost N, Smith E, Nogueira R, Fitzpatrick K, Yoo A, Hirsch J, Schwamm L. Implementation of a patient selection protocol for intra-arterial therapy increases treatment rates in patients with acute ischemic stroke. Journal Of NeuroInterventional Surgery 2012, 5: i44. PMID: 22611045, PMCID: PMC3777532, DOI: 10.1136/neurintsurg-2011-010240.Peer-Reviewed Original ResearchConceptsIntra-arterial therapyAcute ischemic strokePatient selection protocolLTB patientsIschemic strokeIntravenous tissue plasminogen activatorNIH Stroke Scale scoreTreatment ratesProximal artery occlusionStroke Scale scoreTissue plasminogen activatorProtocol adoptionStroke durationInfarct volumeArtery occlusionMost patientsMultivariable adjustmentIndependent predictorsPatient selectionStroke databasePatientsScale scorePlasminogen activatorStudy periodBrain imagingPredictors of Rapid Brain Imaging in Acute Stroke
Kelly A, Hellkamp A, Olson D, Smith E, Schwamm L. Predictors of Rapid Brain Imaging in Acute Stroke. Stroke 2012, 43: 1279-1284. PMID: 22442169, DOI: 10.1161/strokeaha.111.626374.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedDiabetes MellitusEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHumansMagnetic Resonance ImagingMaleMultivariate AnalysisNeuroimagingPractice Guidelines as TopicRacial GroupsRetrospective StudiesSex FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTomography, X-Ray ComputedConceptsEmergency department arrivalBrain imagingSymptom onsetHealth Stroke Scale scoreFuture quality improvement initiativesGuidelines-Stroke programStroke Scale scoreStroke symptom onsetAcute stroke symptomsHistory of diabetesPeripheral vascular diseaseMultivariable logistic regressionQuality improvement initiativesEffectiveness of thrombolysisOverall imaging rateProsthetic heart valvesPredictive variablesAcute strokeMost patientsHospital clusteringIndependent predictorsStroke symptomsNonwhite raceEmergency departmentVascular diseaseInfarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy
Yoo A, Chaudhry Z, Nogueira R, Lev M, Schaefer P, Schwamm L, Hirsch J, González R. Infarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy. Stroke 2012, 43: 1323-1330. PMID: 22426317, DOI: 10.1161/strokeaha.111.639401.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overBiomarkersBrain InfarctionCohort StudiesDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousMagnetic Resonance ImagingMaleMiddle AgedNeuroimagingPredictive Value of TestsProspective StudiesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsFinal infarct volumeIntra-arterial therapyAcute ischemic strokeInfarct volumeFunctional outcomeBetter outcomesIschemic strokePoor outcomeAnterior circulation acute ischemic strokeScale scoreHealth Stroke Scale scoreMedian admission National InstitutesMedian final infarct volumesLong-term functional outcomeIntra-arterial stroke therapyAdmission National InstitutesProximal artery occlusionStroke Scale scoreOnly independent predictorRankin Scale scoreArtery occlusionProspective cohortRankin ScaleIndependent predictorsClinical outcomesPeripartum Subarachnoid Hemorrhage
Bateman B, Olbrecht V, Berman M, Minehart R, Schwamm L, Leffert L. Peripartum Subarachnoid Hemorrhage. Anesthesiology 2012, 116: 324-333. PMID: 22166951, DOI: 10.1097/aln.0b013e3182410b22.Peer-Reviewed Original ResearchConceptsSubarachnoid hemorrhageHypertensive disordersRisk factorsPregnancy-related admissionsIndependent risk factorIntracranial venous thrombosisNationwide Inpatient SampleAfrican American raceVariety of etiologiesRange of etiologiesSickle cell diseaseIdentified admissionsHospital deathMaternal morbidityNonpregnant patientsNonpregnant womenIndependent predictorsMalignant etiologySevere headacheVenous thrombosisNonpregnant controlsPregnancy resultsVenous bleedingInstitution experienceInpatient Sample
2011
CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients
Thomas L, Goldstein J, Hakimelahi R, Chang Y, Yoo A, Schwamm L, Gonzalez R. CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients. International Journal Of Emergency Medicine 2011, 4: 62. PMID: 21967677, PMCID: PMC3203028, DOI: 10.1186/1865-1380-4-62.Peer-Reviewed Original ResearchCerebral artery occlusionProximal cerebral artery occlusionEmergent CT angiographyIschemic stroke patientsCT angiographyProximal occlusionArtery occlusionNegative predictive valuePositive predictive valueIndependent predictorsStroke patientsNeurointerventional servicesInitial NIH Stroke Scale scorePredictive valueConsecutive ischemic stroke patientsAcute ischemic stroke patientsNIH Stroke Scale scoreInterventional servicesMechanical clot retrievalTertiary care interventionsIntra-arterial thrombolysisStroke Scale scoreAcute ischemic strokeTertiary care centerHistorical cohort studyOutcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator
Smith E, Fonarow G, Reeves M, Cox M, Olson D, Hernandez A, Schwamm L. Outcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator. Stroke 2011, 42: 3110-3115. PMID: 21903949, DOI: 10.1161/strokeaha.111.613208.Peer-Reviewed Original ResearchConceptsRecombinant tissue-type plasminogen activatorIntravenous recombinant tissue-type plasminogen activatorHealth Stroke Scale scoreStroke Scale scoreTissue-type plasminogen activatorHospital dischargePoor outcomeRisk factorsNationwide studyScale scorePoor short-term outcomePlasminogen activatorInitial National InstitutesHigher National InstitutesIschemic stroke patientsLipid-lowering medicationsVascular risk factorsMultivariable-adjusted analysesShort-term outcomesStroke-related disabilityLarge nationwide studyNational InstituteReperfusion therapyHome dischargeIndependent predictorsSecondary preventive medication persistence and adherence 1 year after stroke
Bushnell C, Olson D, Zhao X, Pan W, Zimmer L, Goldstein L, Alberts M, Fagan S, Fonarow G, Johnston S, Kidwell C, LaBresh K, Ovbiagele B, Schwamm L, Peterson E. Secondary preventive medication persistence and adherence 1 year after stroke. Neurology 2011, 77: 1182-1190. PMID: 21900638, PMCID: PMC3265047, DOI: 10.1212/wnl.0b013e31822f0423.Peer-Reviewed Original ResearchConceptsSecondary prevention medicationsPrevention medicationsSystem-level factorsMedication persistenceHospital dischargeIndependent predictorsIschemic stroke Longitudinal (AVAIL) registryGuidelines-Stroke programSecondary preventive medicationsUse of warfarinPrimary care providersAmerican Heart AssociationHealth care providers' instructionsLong-term useHospitalization dischargeModifiable patientDiabetes medicationsIschemic strokePreventive medicationsStroke patientsHeart AssociationCare providersMedicationsSide effectsPatients
2010
Risk Score for In-Hospital Ischemic Stroke Mortality Derived and Validated Within the Get With The Guidelines–Stroke Program
Smith E, Shobha N, Dai D, Olson D, Reeves M, Saver J, Hernandez A, Peterson E, Fonarow G, Schwamm L. Risk Score for In-Hospital Ischemic Stroke Mortality Derived and Validated Within the Get With The Guidelines–Stroke Program. Circulation 2010, 122: 1496-1504. PMID: 20876438, DOI: 10.1161/circulationaha.109.932822.Peer-Reviewed Original ResearchConceptsShort-term mortality riskIschemic stroke mortalityNIHSS scoreHospital mortalityC-statisticStroke mortalityPatients' short-term mortality riskHealth Stroke Scale scoreGuidelines-Stroke programHistory of dyslipidemiaValidate prediction modelsMortality risk stratificationStroke Scale scoreIschemic stroke patientsPeripheral vascular diseasePrevious myocardial infarctionPractical bedside toolValidation sampleCurrent smokingIschemic strokeDiabetes mellitusIndependent predictorsPrevious strokeRisk stratificationAtrial fibrillationManagement of Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage
Goldstein J, Marrero M, Masrur S, Pervez M, Barrocas A, Abdullah A, Oleinik A, Rosand J, Smith E, Dzik W, Schwamm L. Management of Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage. JAMA Neurology 2010, 67: 965-969. PMID: 20697046, PMCID: PMC3690951, DOI: 10.1001/archneurol.2010.175.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageIntra-arterial thrombolysisHospital mortalityIntracerebral hemorrhageHealth Stroke Scale scoreIntravenous tissue plasminogen activatorGuidelines-Stroke databaseStroke Scale scoreAcute ischemic strokeMultivariable logistic regressionFresh frozen plasmaTissue plasminogen activatorMulticenter registryAcute strokeDevastating complicationIschemic strokeIndependent predictorsThrombolytic therapyFrozen plasmaAppropriate treatmentRetrospective analysisPatientsScale scoreCoagulopathyThrombolysisRisk of Thrombolytic Therapy for Acute Ischemic Stroke in Patients With Current Malignancy
Masrur S, Abdullah A, Smith E, Hidalgo R, El-Ghandour A, Rordorf G, Schwamm L. Risk of Thrombolytic Therapy for Acute Ischemic Stroke in Patients With Current Malignancy. Journal Of Stroke And Cerebrovascular Diseases 2010, 20: 124-130. PMID: 20598579, DOI: 10.1016/j.jstrokecerebrovasdis.2009.10.010.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBostonBrain IschemiaChi-Square DistributionComorbidityFemaleFibrinolytic AgentsHospital MortalityHumansIntracranial HemorrhagesLogistic ModelsMaleNeoplasmsOdds RatioRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeConceptsIntra-arterial therapyTissue plasminogen activatorSymptomatic intracranial hemorrhageCurrent malignancyHospital mortalityMedical comorbiditiesThrombolytic therapyIntracranial hemorrhageIndependent predictorsAIS patientsIntravenous (IV) tPAHealth Stroke Scale scoreStroke Scale scoreAcute ischemic strokeConsecutive AIS patientsHistory of hypertensionHistory of malignancyAmerican Stroke AssociationOnly independent predictorRisks of thrombolysisMost clinical trialsStepwise logistic regressionBrain metastasesIschemic strokePerformance status
2009
A score to predict early risk of recurrence after ischemic strokeSYMBOLSYMBOL
Ay H, Gungor L, Arsava E, Rosand J, Vangel M, Benner T, Schwamm L, Furie K, Koroshetz W, Sorensen A. A score to predict early risk of recurrence after ischemic strokeSYMBOLSYMBOL. Neurology 2009, 74: 128-135. PMID: 20018608, PMCID: PMC2809031, DOI: 10.1212/wnl.0b013e3181ca9cff.Peer-Reviewed Original ResearchConceptsRecurrent strokeEarly riskPrognostic scoreConsecutive ischemic stroke patientsComprehensive prognostic scoreTIA/strokeAcute stroke careIschemic stroke patientsPredictors of recurrenceRisk of recurrenceCox regression modelEtiologic stroke subtypesPatient management algorithmsBrain infarctsAcute settingIschemic strokeStroke subtypesIndependent predictorsStroke careStroke patientsImaging featuresPrior historySeparate cohortClinical practiceStroke
2008
Clinical- and Imaging-Based Prediction of Stroke Risk After Transient Ischemic Attack
Ay H, Arsava E, Johnston S, Vangel M, Schwamm L, Furie K, Koroshetz W, Sorensen A. Clinical- and Imaging-Based Prediction of Stroke Risk After Transient Ischemic Attack. Stroke 2008, 40: 181-186. PMID: 18948609, DOI: 10.1161/strokeaha.108.521476.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrainComorbidityComputer SimulationDiffusion Magnetic Resonance ImagingDisease ProgressionEarly DiagnosisEmergency Medical ServicesFemaleHumansIncidenceIschemic Attack, TransientLogistic ModelsMaleMiddle AgedNeurologic ExaminationPredictive Value of TestsPrognosisReproducibility of ResultsRisk FactorsStrokeConceptsTransient ischemic attackIschemic attackStroke riskClinical featuresDiffusion-weighted imagingAcute infarctsClinical transient ischemic attackDiffusion-weighted imaging findingsEarly stroke riskRelevant clinical settingsCharacteristic curveLogistic regression modelsConsecutive patientsSymptom onsetIndependent predictorsRisk stratificationImaging findingsTherapeutic measuresHospital resourcesEarly riskClinical settingResponse criteriaPredictive instrumentStrokeSubsequent strokeCT Angiography-Source Image Hypoattenuation Predicts Clinical Outcome in Posterior Circulation Strokes Treated With Intra-Arterial Therapy
Schaefer P, Yoo A, Bell D, Barak E, Romero J, Nogueira R, Lev M, Schwamm L, Gonzalez R, Hirsch J. CT Angiography-Source Image Hypoattenuation Predicts Clinical Outcome in Posterior Circulation Strokes Treated With Intra-Arterial Therapy. Stroke 2008, 39: 3107-3109. PMID: 18703807, DOI: 10.1161/strokeaha.108.517680.Peer-Reviewed Original ResearchConceptsIntra-arterial thrombolysisVertebrobasilar occlusionClinical outcomesParenchymal hypoattenuationRankin scorePosterior circulation strokeHealth Stroke ScaleIntra-arterial therapyOnly independent predictorIndependent outcome predictorsMedial temporal lobeInferior parietal lobeStroke ScaleClot locationPatient ageCTA-SIIndependent predictorsOutcome predictorsOccipital lobeHypoattenuationTemporal lobeThrombolysisParietal lobePatientsMidbrainRole of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based “Benefit of Recanalization” Model
Rosenthal E, Schwamm L, Roccatagliata L, Coutts S, Demchuk A, Schaefer P, Gonzalez R, Hill M, Halpern E, Lev M. Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based “Benefit of Recanalization” Model. American Journal Of Neuroradiology 2008, 29: 1471-1475. PMID: 18599577, PMCID: PMC8119059, DOI: 10.3174/ajnr.a1153.Peer-Reviewed Original ResearchConceptsOnly independent predictorLesion volumeComplete recanalizationRecanalization statusClinical outcomesNIHSS scoreIndependent predictorsIncomplete recanalizationCTA-SI Alberta Stroke Program Early CT ScoreAcute middle cerebral artery strokeAlberta Stroke Program Early CT ScoreHealth Stroke Scale scoreMedian admission NIHSS scoreMiddle cerebral artery strokeCT angiographic source imagesAcute stroke outcomeAdmission National InstitutesBenefit of recanalizationEarly successful recanalizationMCA M1 occlusionRole of recanalizationStroke Scale scoreAdmission NIHSS scoreMRS score 0CT/CTA