2022
Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke
Mendelson S, Zhang S, Matsouaka R, Xian Y, Shah S, Lytle B, Solomon N, Schwamm L, Smith E, Saver J, Fonarow G, Holl J, Prabhakaran S. Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Neurology 2022, 98: e1596-e1604. PMID: 35228335, PMCID: PMC9052571, DOI: 10.1212/wnl.0000000000200138.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorNon-Hispanic black patientsTPA-eligible patientsRace/ethnicityBlack patientsNon-Hispanic black race/ethnicityNon-Hispanic white patientsBlack race/ethnicityAsian race/ethnicityGuidelines-Stroke registryPrimary stroke centerSingle-center studyMultivariable logistic regressionRace-ethnic disparitiesNon-Hispanic whitesEligible patientsHospital factorsNationwide registryPatient demographicsStroke centersSymptom onsetWhite patientsMultivariable analysisStroke careAsian patients
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
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 regressionCurrent Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage
Cherian L, Smith E, Schwamm L, Fonarow G, Schulte P, Xian Y, Wu J, Prabhakaran S. Current Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage. Neurosurgery 2017, 82: 85-92. PMID: 28379461, DOI: 10.1093/neuros/nyx146.Peer-Reviewed Original ResearchConceptsHospital day 2Early chemoprophylaxisIntracerebral hemorrhageVTE prophylaxisDay 2Venous thromboembolismEarly Venous Thromboembolism ProphylaxisEarly VTE prophylaxisGuidelines-Stroke registryMechanical VTE prophylaxisPrior ischemic strokeCP useTransient ischemic attackVenous thromboembolism prophylaxisObservational cohort studyPeripheral artery diseaseMultivariable logistic regressionAcute care facilitiesComfort care measuresCurrent practice trendsIschemic attackProphylaxis statusThromboembolism prophylaxisMechanical prophylaxisCohort studyHealthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes
O'Brien E, Wu J, Zhao X, Schulte P, Fonarow G, Hernandez A, Schwamm L, Peterson E, Bhatt D, Smith E. Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes. Journal Of The American Heart Association 2017, 6: e003813. PMID: 28159820, PMCID: PMC5523738, DOI: 10.1161/jaha.116.003813.Peer-Reviewed Original ResearchConceptsHealthcare resource availabilityHospital referral regionsQuality of careReferral regionsHealthcare resourcesAcute ischemic stroke outcomesAcute ischemic stroke treatmentGuidelines-Stroke hospitalsIschemic stroke outcomeIschemic stroke patientsIschemic stroke treatmentMultivariable logistic regressionLength of stayHospital-based resourcesGuidelines-StrokeHospital mortalityHospital outcomesStroke outcomeStroke careStroke treatmentStroke patientsCare resourcesHealth care dataHospital qualityStroke quality
2016
Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke
Medford‐Davis L, Fonarow G, Bhatt D, Xu H, Smith E, Suter R, Peterson E, Xian Y, Matsouaka R, Schwamm L. Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke. Journal Of The American Heart Association 2016, 5: e004282. PMID: 27930356, PMCID: PMC5210352, DOI: 10.1161/jaha.116.004282.Peer-Reviewed Original ResearchMeSH KeywordsAgedAmbulancesAnticholesteremic AgentsAntihypertensive AgentsBrain IschemiaDiabetes MellitusFemaleGuideline AdherenceHospital MortalityHumansHypercholesterolemiaHypertensionHypoglycemic AgentsInsurance CoverageInsurance, HealthLogistic ModelsMaleMedicaidMedically UninsuredMedicareMiddle AgedMultivariate AnalysisOdds RatioPractice Guidelines as TopicSkilled Nursing FacilitiesStrokeStroke RehabilitationTime FactorsUnited StatesConceptsAcute ischemic strokeIschemic strokeInsurance statusHospital mortalityGuidelines-Stroke programIschemic stroke patientsMultivariable logistic regressionPatient insurance statusGovernment-sponsored insuranceSkilled nursing facilitiesGuidelines-StrokeInpatient rehabPostdischarge destinationHospital outcomesPatient demographicsSymptom onsetAcute treatmentControl medicationDiabetes mellitusStroke patientsHospital characteristicsUninsured patientsHigh cholesterolNursing facilitiesPreventative care
2015
Increased Risk of Cerebrovascular Disease Among Patients With Neurofibromatosis Type 1
Terry A, Jordan J, Schwamm L, Plotkin S. Increased Risk of Cerebrovascular Disease Among Patients With Neurofibromatosis Type 1. Stroke 2015, 47: 60-65. PMID: 26645253, DOI: 10.1161/strokeaha.115.011406.Peer-Reviewed Original ResearchConceptsNeurofibromatosis type 1Ischemic strokeIntracerebral hemorrhageGeneral populationCases of NF1US Nationwide Inpatient SampleType 1Hemorrhagic stroke typesNew neurological symptomsStroke risk factorsRisk of strokeOdds of strokeTime of strokeNationwide Inpatient SampleMultivariable logistic regressionCase-control studyType of strokeYounger mean ageAdult patientsPediatric patientsHemorrhagic strokeNeurological symptomsCerebrovascular diseaseMean ageInpatient SampleRacial/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 regressionNovel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack
Patel P, Zhao X, Fonarow G, Lytle B, Smith E, Xian Y, Bhatt D, Peterson E, Schwamm L, Hernandez A. Novel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack. Circulation Cardiovascular Quality And Outcomes 2015, 8: 383-392. PMID: 26058721, PMCID: PMC4512906, DOI: 10.1161/circoutcomes.114.000907.Peer-Reviewed Original ResearchConceptsNovel oral anticoagulantsTransient ischemic attackAtrial fibrillation patientsIschemic attackIschemic strokeFibrillation patientsEligible patientsWarfarin therapyAtrial fibrillationNovel oral anticoagulant useCHA2DS2-VASc scoreRate of anticoagulationOral anticoagulant useLower stroke riskMultivariable logistic regressionAnticoagulation ratesGuidelines-StrokeNOAC useAnticoagulant useOral anticoagulantsStroke riskRisk factorsStudy populationPatterns of usePatients
2014
Hospital Case Volume Is Associated With Mortality in Patients Hospitalized With Subarachnoid Hemorrhage
Prabhakaran S, Fonarow G, Smith E, Liang L, Xian Y, Neely M, Peterson E, Schwamm L. Hospital Case Volume Is Associated With Mortality in Patients Hospitalized With Subarachnoid Hemorrhage. Neurosurgery 2014, 75: 500-508. PMID: 24979097, DOI: 10.1227/neu.0000000000000475.Peer-Reviewed Original ResearchConceptsHospital case volumeHospital mortalitySubarachnoid hemorrhageCase volumeSAH volumeSAH patientsHospital characteristicsMedian annual case volumeGuidelines-Stroke registryLarge nationwide registryMultivariable logistic regressionLength of stayAnnual case volumeContemporary national dataIndependent ambulatory statusAmbulatory statusExperienced centersNationwide registryDischarge diagnosisOptimized careImproved outcomesRelevant patientsPatientsHospitalMortalityRacial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage
Xian Y, Holloway R, Smith E, Schwamm L, Reeves M, Bhatt D, Schulte P, Cox M, Olson D, Hernandez A, Lytle B, Anstrom K, Fonarow G, Peterson E. Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage. Stroke 2014, 45: 3243-3250. PMID: 25213344, DOI: 10.1161/strokeaha.114.005620.Peer-Reviewed Original ResearchConceptsWhite patientsAsian patientsRace/ethnicityCessation counselingLower oddsDeep venous thrombosis prophylaxisGuidelines-Stroke hospitalsStroke performance measuresVenous thrombosis prophylaxisHospital-level characteristicsMultivariable logistic regressionProcess of careEthnic differencesHospital mortalityThrombosis prophylaxisCause mortalityHospital outcomesSevere strokeDysphagia screeningBlack patientsIntracerebral hemorrhageMedian lengthHigher oddsStroke educationComfort measures
2012
Risk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue-Type Plasminogen Activator
Menon B, Saver J, Prabhakaran S, Reeves M, Liang L, Olson D, Peterson E, Hernandez A, Fonarow G, Schwamm L, Smith E. Risk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue-Type Plasminogen Activator. Stroke 2012, 43: 2293-2299. PMID: 22811458, DOI: 10.1161/strokeaha.112.660415.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBlood PressureCerebral HemorrhageCohort StudiesData Interpretation, StatisticalEthnicityFemaleFibrinolytic AgentsHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsRisk AssessmentRisk FactorsStrokeTissue Plasminogen ActivatorTreatment OutcomeConceptsIntravenous tissue-type plasminogen activatorSymptomatic intracranial hemorrhageTissue-type plasminogen activatorSICH riskIschemic strokeSymptom onsetIntracranial hemorrhageValidation cohortC-statisticPlasminogen activatorIntravenous tissue-type plasminogen activator treatmentRisk of sICHTissue-type plasminogen activator treatmentHigher baseline National InstitutesHigher systolic blood pressureDerivation sampleBaseline National InstitutesHealth Stroke ScaleStroke symptom onsetAcute ischemic strokeSystolic blood pressurePlasminogen activator treatmentMultivariable logistic regressionHigh blood glucoseNational InstitutePredictors 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 disease
2010
Management 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 scoreCoagulopathyThrombolysisQuality of Care and Outcomes in Patients With Diabetes Hospitalized With Ischemic Stroke
Reeves M, Vaidya R, Fonarow G, Liang L, Smith E, Matulonis R, Olson D, Schwamm L. Quality of Care and Outcomes in Patients With Diabetes Hospitalized With Ischemic Stroke. Stroke 2010, 41: e409-e417. PMID: 20224058, DOI: 10.1161/strokeaha.109.572693.Peer-Reviewed Original ResearchConceptsQuality of careStroke-related outcomesIschemic stroke patientsStroke patientsRt-PACholesterol treatmentIntravenous recombinant tissue plasminogen activatorRecombinant tissue plasminogen activatorCommon comorbid diseasesGuidelines-Stroke programPercent of patientsSecondary prevention treatmentHours of onsetMultivariable logistic regressionTissue plasminogen activatorUnited States hospitalsQuality improvement effortsGWTG-StrokeHospital mortalityDischarge homeHospital deathHospital outcomesStroke recurrenceComorbid diseasesIschemic stroke