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
2016
The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care
Miller JB, Merck LH, Wira CR, Meurer WJ, Schrock JW, Nomura JT, Siket MS, Madsen TE, Wright DW, Panagos PD, Lewandowski C. The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care. Annals Of Emergency Medicine 2016, 69: 192-201. PMID: 27600649, DOI: 10.1016/j.annemergmed.2016.06.042.Peer-Reviewed Original ResearchMeSH KeywordsBlood Vessel ProsthesisEmergency Service, HospitalEndovascular ProceduresFibrinolytic AgentsHumansStentsStrokeThrombolytic TherapyConceptsStroke careLarge-vessel ischemic strokeEndovascular stroke treatmentIschemic stroke careEmergency medicine cliniciansEndovascular careReperfusion eraIschemic strokeStroke treatmentEndovascular treatmentTreatment paradigmLeading causeMedicine cliniciansTimely treatmentCarePatientsHospitalTreatmentMorbidityStrokeMortalityCliniciansCentral roleValidation 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 datasetHospital
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 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 ResearchMeSH KeywordsAgedBrain IschemiaCerebral HemorrhageFemaleHumansMaleOutcome Assessment, Health CarePrognosisStrokeThrombolytic TherapyTissue Plasminogen ActivatorConceptsSymptomatic 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 curveHemorrhageCohort-Based Identification of Predictors 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. Cohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocritical Care 2015, 23: 394-400. PMID: 25691004, DOI: 10.1007/s12028-015-0121-1.Peer-Reviewed Original ResearchConceptsRt-PA therapyEarly CT hypodensityHyperdense MCA signCT hypodensityIschemic strokeIndependent predictorsRisk of sICHSymptomatic intracerebral hemorrhageAcute ischemic strokeVisual field deficitsNew independent predictorAdditional independent predictorsCase-control studyIdentification of predictorsLevel of consciousnessTwo-sample t-testMann-Whitney testAntithrombolytic therapyStroke centersField deficitsSerious complicationsIntracerebral hemorrhageClinical parametersIntracranial hemorrhageTherapy
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