2021
Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis
Wu X, Wira C, Matouk C, Forman H, Gandhi D, Sanelli P, Schindler J, Malhotra A. Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis. International Journal Of Stroke 2021, 17: 315-322. PMID: 33759645, DOI: 10.1177/17474930211008701.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaHumansPatient TransferStrokeThrombectomyThrombolytic TherapyTime-to-TreatmentTreatment OutcomeTriageConceptsComprehensive stroke centerPrimary stroke centerAcute stroke patientsNearest comprehensive stroke centerAcute strokeMothership strategyStroke centersStroke patientsPlace of onsetHealth benefitsMarkov decision-analytic modelComparative effectiveness analysisRecent medical literatureMultiple sensitivity analysesDecision analytic modelMothership modelPrimary outcomeEndovascular treatmentPrehospital triageSudden onsetPatientsMedical literatureStrokeShip strategyTarget population
2020
Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitals
2017
Neurology Concepts: Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department
Chang BP, Wira C, Miller J, Akhter M, Barth BE, Willey J, Nentwich L, Madsen T. Neurology Concepts: Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department. Academic Emergency Medicine 2017, 25: 54-64. PMID: 28646558, PMCID: PMC6415947, DOI: 10.1111/acem.13243.Peer-Reviewed Original ResearchConceptsIschemic strokeYoung womenEmergency departmentRisk factorsSex-specific risk factorsIschemic stroke evaluationAcute ischemic strokeOral contraceptive useBoard-certified emergency physiciansPremenopausal womenAcute settingBroad differentialCerebral hemorrhageStroke evaluationVascular neurologistsNonpregnant individualsPostpartum periodLeading causeEmergency physiciansTimely diagnosisContraceptive useThrombolytic agentsCurrent evidenceStrokeOlder population
2016
Volume of Plasma Expansion and Functional Outcomes in Stroke
Miller JB, Lewandowski C, Wira CR, Taylor A, Burmeister C, Welch R. Volume of Plasma Expansion and Functional Outcomes in Stroke. Neurocritical Care 2016, 26: 191-195. PMID: 27629275, DOI: 10.1007/s12028-016-0316-0.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaFemaleHumansMaleMiddle AgedOutcome Assessment, Health CarePlasmaSerum AlbuminSodium ChlorideStrokeConceptsNeurological recoveryNIHSS scoreIschemic strokeFunctional outcomeFavorable outcomeMultivariable-adjusted logistic regression modelsModified Rankin Scale scoreLarge-vessel ischemic strokeHigher NIHSS scoreIsotonic saline treatmentMedian National InstitutesWorse neurological recoveryHealth Stroke ScaleAcute ischemic strokeMultivariable-adjusted modelsRankin Scale scoreIntravenous volume infusionConclusionsThe present studyLogistic regression modelsStroke ScaleStudy patientsAcute strokeCerebral perfusionClinical outcomesMean ageValidation of TURN, a simple predictor of symptomatic intracerebral hemorrhage after IV thrombolysis
Asuzu D, Nystrӧm K, Amin H, Schindler J, Wira C, Greer D, Fang NF, Halliday J, Sheth KN. Validation of TURN, a simple predictor of symptomatic intracerebral hemorrhage after IV thrombolysis. Clinical Neurology And Neurosurgery 2016, 146: 71-75. PMID: 27152469, DOI: 10.1016/j.clineuro.2016.04.017.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageIntracerebral hemorrhageRt-PAOdds ratioYale-New Haven HospitalNINDS rt-PA trialIschemic stroke patientsNew Haven HospitalTwo-sample t-testStroke patientsCharacteristic curveThrombolysisHemorrhageSignificant differencesPatientsT-testScoresExternal datasetSimple predictorInternal datasetHospitalRisk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis
Asuzu D, Nystrӧm K, Schindler J, Wira C, Greer D, Halliday J, Sheth KN. Risk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis. Clinical Neurology And Neurosurgery 2016, 142: 148-152. PMID: 26875069, DOI: 10.1016/j.clineuro.2016.01.030.Peer-Reviewed Original ResearchMissed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services
Arch AE, Weisman DC, Coca S, Nystrom KV, Wira CR, Schindler JL. Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services. Stroke 2016, 47: 668-673. PMID: 26846858, DOI: 10.1161/strokeaha.115.010613.Peer-Reviewed Original ResearchConceptsEmergency departmentLarge community hospitalCommunity hospitalIschemic strokeStroke diagnosisAcademic hospitalNausea/vomitingSecondary prevention therapiesAcute ischemic strokeRetrospective chart reviewIschemic stroke diagnosisAcademic teaching hospitalEndovascular considerationsChart reviewPrompt treatmentSymptom onsetPosterior circulationPrevention therapyNeurology serviceAcute interventionAnterior strokeAtypical symptomsStroke historyPosterior strokeTeaching hospital
2015
On- versus Off-Hour Patient Cohorts at a Primary Stroke Center: Onset-to-Treatment Duration and Clinical Outcomes after IV Thrombolysis
Asuzu D, Nystrӧm K, Amin H, Schindler J, Wira C, Greer D, Fang NF, Halliday J, Sheth KN. On- versus Off-Hour Patient Cohorts at a Primary Stroke Center: Onset-to-Treatment Duration and Clinical Outcomes after IV Thrombolysis. Journal Of Stroke And Cerebrovascular Diseases 2015, 25: 447-451. PMID: 26654664, DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.017.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhagePrimary stroke centerClinical outcomesStroke centersStroke severitySymptom onsetStroke careStroke patientsPatient cohortIntravenous recombinant tissue plasminogen activator (rt-PA) therapyTreatment durationRecombinant tissue plasminogen activator therapyHealth Stroke Scale scoreTissue plasminogen activator therapyConsistent quality careBaseline National InstitutesStroke Scale scoreAcute stroke careIschemic stroke patientsPlasminogen activator therapyMann-Whitney testSICH rateAcute strokeIschemic strokeConsecutive patientsTURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis
Asuzu D, Nyström K, Sreekrishnan A, Schindler J, Wira C, Greer D, Halliday J, Kimberly WT, Sheth KN. TURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis. Neurocritical Care 2015, 24: 381-388. PMID: 26341364, DOI: 10.1007/s12028-015-0198-6.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageBrain swellingIntracerebral hemorrhageCerebral edemaPoor outcomeSevere outcomesOdds ratioLogistic regression reporting odds ratiosNINDS rt-PA trialIschemic stroke patientsReporting odds ratioNew brainNew onsetMidline shiftStroke patientsRt-PAEdemaThrombolysisMortalityOutcomesMass effectCharacteristic curveHemorrhagePatientsStatistical associationTURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis
Asuzu D, Nyström K, Schindler J, Wira C, Greer D, Halliday J, Sheth KN. TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis. Neurocritical Care 2015, 23: 172-178. PMID: 26032809, DOI: 10.1007/s12028-015-0154-5.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageGOS scoreSevere outcomesConfidence intervalsOdds ratioLogistic regression reporting odds ratiosScale scoreAcute ischemic stroke patientsGlasgow Outcome Scale scoreSPAN-100NINDS rt-PA trialIschemic stroke patientsBarthel Index scoreRankin Scale scoreReporting odds ratioStroke-TPIMRS scoreIntracerebral hemorrhageClinical scoresStroke patientsExcellent outcomesRt-PABI scoreIndex scoreOutcomesTURN: A Simple Predictor of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis
Asuzu D, Nyström K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. TURN: A Simple Predictor of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocritical Care 2015, 23: 166-171. PMID: 25869481, DOI: 10.1007/s12028-015-0131-z.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageBaseline NIHSS scorePrestroke mRS scoreNIHSS scoreMRS scoreIntracerebral hemorrhageRt-PAOdds ratioYale-New Haven HospitalNINDS rt-PA trialIschemic stroke patientsIschemic stroke treatmentIndependent predictorsStroke treatmentStroke patientsClinical parametersPlatelet countHyperacute strokeDerivation datasetThrombolysisLogistic regressionSubstantial riskNew scoreCharacteristic curveHemorrhage
2014
Modest Association between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis
Asuzu D, Nystrom K, Amin H, Schindler J, Wira C, Greer D, Fang NF, Halliday J, Sheth KN. Modest Association between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis. Journal Of Stroke And Cerebrovascular Diseases 2014, 24: 548-553. PMID: 25540072, DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.034.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousArea Under CurveBrain IschemiaCerebral HemorrhageChi-Square DistributionConnecticutDecision Support TechniquesDisability EvaluationFemaleFibrinolytic AgentsHumansLogistic ModelsMaleOdds RatioPatient DischargePredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsROC CurveStrokeThrombolytic TherapyTime FactorsTreatment OutcomeConceptsDischarge mRS scoreSymptomatic intracerebral hemorrhageRankin Scale scoreMRS scoreClinical scoresAdverse outcomesIntracerebral hemorrhageScale scoreModified Rankin Scale scoreLong-term adverse outcomesYale-New Haven HospitalIntravenous thrombolytic therapyIschemic stroke patientsUnivariate logistic regressionHosmer-Lemeshow statisticNew Haven HospitalMRS dataIntravenous thrombolysisThrombolytic therapyStroke patientsClinical benefitModest agreementClinical dataLogistic regressionModest associationComparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis
Asuzu D, Nystrom K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. Comparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis. Neurocritical Care 2014, 22: 229-233. PMID: 25168743, DOI: 10.1007/s12028-014-0060-2.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageRt-PA therapyStroke-TPIThrombolytic therapyClinical scoresIntracerebral hemorrhageOdds ratioPredictors of sICHAcute ischemic stroke patientsYale-New Haven HospitalRt-PA treatmentIschemic stroke patientsHosmer-Lemeshow statisticBackgroundIntracerebral hemorrhageConsecutive patientsFeared complicationMethodsClinical dataStroke patientsAdverse outcomesStudy criteriaPatientsTherapyHemorrhageLogistic regressionSPAN-100
2011
Epidemiology and Outcomes of Fever Burden Among Patients With Acute Ischemic Stroke
Phipps MS, Desai RA, Wira C, Bravata DM. Epidemiology and Outcomes of Fever Burden Among Patients With Acute Ischemic Stroke. Stroke 2011, 42: 3357-3362. PMID: 21980196, DOI: 10.1161/strokeaha.111.621425.Peer-Reviewed Original ResearchConceptsHigher fever burdenFever burdenFever eventsIschemic strokeStroke patientsAcute ischemic stroke patientsAcute ischemic strokeIschemic stroke patientsOdds of deathPoor patient outcomesAspects of feverFever daysHospital mortalityMedian tmaxClinical characteristicsRetrospective cohortStroke severityFebrile patientsFever episodesOutcome ratesOdds ratioPatient outcomesPatientsFeverLogistic regression