2022
Rationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China
Li Z, Wang C, Zhang X, Zong L, Zhou H, Gu H, Jiang Y, Pan Y, Meng X, Zhou Q, Zhao H, Yang X, Wang M, Xiong Y, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y. Rationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China. Stroke And Vascular Neurology 2022, 7: 451-456. PMID: 35354662, PMCID: PMC9614172, DOI: 10.1136/svn-2021-001461.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous thrombolysisReperfusion therapyEndovascular thrombectomyEligible patientsPrimary outcomeWedge clusterQuality improvement interventionsMixed-effects logistic regressionTreatment qualityIntraclass correlation coefficientReperfusion treatmentHospital delayIschemic strokeStroke centersTreat principleStroke careEfficacy analysisChina trialEffective treatmentNumber of casesImprovement interventionsPatientsComprehensive interventionLogistic regression
2021
Disparities In Telehealth Use Among California Patients With Limited English Proficiency
Rodriguez J, Saadi A, Schwamm L, Bates D, Samal L. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Affairs 2021, 40: 487-495. PMID: 33646862, DOI: 10.1377/hlthaff.2020.00823.Peer-Reviewed Original ResearchConceptsLimited English proficiencyTelehealth useCalifornia Health Interview SurveyEmergency department useMultivariable logistic regressionHealth Interview SurveyHealth care accessCalifornia patientsDepartment useCare accessPatientsClinical teamCare deliveryTelehealth servicesLogistic regressionInterview SurveyLower ratesTelehealthEnglish proficiencyLanguage barriersClinicians
2020
Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States.
Prabhakaran S, Messé S, Kleindorfer D, Smith E, Fonarow G, Xu H, Zhao X, Lytle B, Cigarroa J, Schwamm L. Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States. Neurology Clinical Practice 2020, 10: 396-405. PMID: 33299667, PMCID: PMC7717635, DOI: 10.1212/cpj.0000000000000736.Peer-Reviewed Original ResearchCryptogenic strokeIschemic strokeStroke etiologyDischarge outcomesHospital treatmentHospital characteristicsMultivariable logistic regressionGWTG-StrokeStroke RegistryNationwide registryMultivariable analysisPatientsLower mortalityHigh mortalityNationwide dataLogistic regressionSubtypesStrokeNational InstituteScale scaleOutcomesTreatmentRegistryHospitalEtiology
2019
Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
Zachrison K, Onnela J, Reeves M, Hernandez A, Camargo C, Zhao X, Matsouaka R, Goldstein J, Metlay J, Schwamm L. Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States. Journal Of The American Heart Association 2019, 9: e011575. PMID: 31888430, PMCID: PMC6988147, DOI: 10.1161/jaha.118.011575.Peer-Reviewed Original ResearchMeSH KeywordsCatchment Area, HealthDatabases, FactualDelivery of Health Care, IntegratedFibrinolytic AgentsHospitalsHospitals, High-VolumeHospitals, Low-VolumeHumansMedicarePatient TransferPractice Patterns, Physicians'Quality Indicators, Health CareRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeAlteplase administrationIschemic strokeUS hospitalsHospital qualityHospital stroke volumeTransfer destinationsHospital referral regionsHospital factorsNumber of hospitalsStroke patientsHospital characteristicsStroke volumeMedicare claimsReferral regionsHospitalLogistic regressionStrokePatientsHospital performancePotential strategyAdministrationHome timeResult dataConnected dyadsResource utilisation among patients transferred for intracerebral haemorrhage
Zachrison K, Aaronson E, Mahmood S, Rosand J, Viswanathan A, Schwamm L, Goldstein J. Resource utilisation among patients transferred for intracerebral haemorrhage. Stroke And Vascular Neurology 2019, 4: 223. PMID: 32030206, PMCID: PMC6979870, DOI: 10.1136/svn-2019-000255.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAge FactorsAgedAged, 80 and overCerebral HemorrhageCritical CareFemaleGlasgow Coma ScaleHumansIntensive Care UnitsMaleMiddle AgedNeurosurgical ProceduresPatient AdmissionPatient TransferProspective StudiesRegistriesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeConceptsGlasgow Coma ScoreIntracerebral hemorrhageSurgical interventionICH scoreAcademic hospitalBaseline Glasgow Coma ScoreIntensive care unit admissionCare unit admissionSingle academic hospitalPrimary intracerebral hemorrhageUrban academic hospitalLess frequent useCollected registryICU stayUnit admissionComa ScoreConsecutive patientsIntraventricular hemorrhagePrimary outcomePrimary patientsPatientsHospitalLogistic regressionHemorrhageResource utilisationFrequency of early rapid improvement in stroke severity during interfacility transfer.
Zachrison K, Leslie-Mazwi T, Boulouis G, Goldstein J, Regenhardt R, Viswanathan A, Lauer A, Siddiqui K, Charidimou A, Rost N, Schwamm L. Frequency of early rapid improvement in stroke severity during interfacility transfer. Neurology Clinical Practice 2019, 9: 373-380. PMID: 31750022, PMCID: PMC6814428, DOI: 10.1212/cpj.0000000000000667.Peer-Reviewed Original ResearchNIHSS scoreInterfacility transferMedian initial NIHSS scoreNIH Stroke Scale scoreHigher initial NIHSSInitial NIHSS scoreNIHSS score changeStroke Scale scoreRapid improvementCSC arrivalInitial NIHSSIndex strokeStroke severityPatient characteristicsMedian changeMultivariable modelingScale scoreScore changeLogistic regressionStrokePatientsScores
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 statesPsychiatrySurgeryPediatricsStrokeEarly transition to comfort measures only in acute stroke patients
Prabhakaran S, Cox M, Lytle B, Schulte P, Xian Y, Zahuranec D, Smith E, Reeves M, Fonarow G, Schwamm L. Early transition to comfort measures only in acute stroke patients. Neurology Clinical Practice 2017, 7: 194-204. PMID: 28680764, PMCID: PMC5490382, DOI: 10.1212/cpj.0000000000000358.Peer-Reviewed Original ResearchIntracerebral hemorrhageIschemic strokeStroke patientsHospital characteristicsComfort measuresCMO orderGuidelines-Stroke registryHospital days 0Acute stroke patientsMultivariable logistic regressionRisk-adjusted mortalityLife-sustaining interventionsLife-sustaining treatmentAcute strokeNonambulatory statusHospital factorsMultivariable analysisStudy criteriaFemale sexStroke typeWhite racePatientsDay 0Older ageLogistic regression
2016
Sex and Age Interactions and Differences in Outcomes After Intracerebral Hemorrhage
James M, Cox M, Xian Y, Smith E, Bhatt D, Schulte P, Hernandez A, Fonarow G, Schwamm L. Sex and Age Interactions and Differences in Outcomes After Intracerebral Hemorrhage. Journal Of Women's Health 2016, 26: 380-388. PMID: 27754758, DOI: 10.1089/jwh.2016.5849.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageSex-based interactionsTotal study populationWorse neurological deficitsAge/sexSex differencesAntiplatelet therapyHospital mortalityIschemic strokeNeurological deficitsPatient ageIndependent ambulationICH patientsStroke databaseAtrial fibrillationEarly outcomesPoor outcomeStudy populationCholesterol reducersLogistic regressionWomenTreatment differencesAgeMenHemorrhage
2015
Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines–Stroke Registry
Mochari-Greenberger H, Xian Y, Hellkamp A, Schulte P, Bhatt D, Fonarow G, Saver J, Reeves M, Schwamm L, Smith E. Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines–Stroke Registry. Journal Of The American Heart Association 2015, 4: e002099. PMID: 26268882, PMCID: PMC4599467, DOI: 10.1161/jaha.115.002099.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsianBlack or African AmericanChi-Square DistributionEmergency Medical ServicesFemaleHealth Knowledge, Attitudes, PracticeHispanic or LatinoHospitalizationHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient Acceptance of Health CareRegistriesSex FactorsStrokeTransportation of PatientsUnited StatesWhite PeopleConceptsEmergency medical servicesStroke patientsStroke symptomsEMS useRace/ethnicityHospitalized acute stroke patientsEmergency medical services transportWhite womenGuidelines-Stroke registryAcute stroke patientsMultivariable logistic regressionLevel of consciousnessSex differencesGuidelines-StrokeNational GetIschemic strokeStroke outcomePatient characteristicsPotential confoundersMedical historyEMS transportSex disparitiesPatientsHispanic menLogistic regression
2013
Variable Selection and Prediction Using a Nested, Matched Case-Control Study: Application to Hospital Acquired Pneumonia in Stroke Patients
Qian J, Payabvash S, Kemmling A, Lev MH, Schwamm LH, Betensky RA. Variable Selection and Prediction Using a Nested, Matched Case-Control Study: Application to Hospital Acquired Pneumonia in Stroke Patients. Biometrics 2013, 70: 153-163. PMID: 24320930, PMCID: PMC3954429, DOI: 10.1111/biom.12113.Peer-Reviewed Original ResearchConceptsMassachusetts General HospitalCase-control studyStroke patientsAcute ischemic stroke patientsBrain regionsMatched Case-Control StudyHospital-Acquired PneumoniaIschemic stroke patientsLarge prospective studiesUnconditional logistic regressionCase-control designSpecific brain regionsAcquired PneumoniaAcute infarctionClinical featuresProspective studyClinical variablesGeneral HospitalEpidemiologic studiesPatientsModern imagingLarger studyLogistic regressionAppropriate statistical analysisHAP studiesA 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