Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute (J.H.K., C.Z., H.K., B.B.N., A.L.L.), Weill Cornell Medicine, New York, NY.
Department of Emergency Medicine (J.R.), Weill Cornell Medicine, New York, NY.
Stroke. 2024 Sep;55(9):2247-2253. doi: 10.1161/STROKEAHA.124.046988. Epub 2024 Jul 12.
Previous cohort studies of hospitalized patients with a delayed diagnosis of ischemic stroke found that these patients often had an initial emergency department (ED) diagnosis of a fall. We sought to evaluate whether ED visits for a fall resulting in discharge to home (ie, treat-and-release visits) were associated with increased short-term ischemic stroke risk.
A case-crossover design was used to compare ED visits for falls during case periods (0-15, 16-30, 31-90, and 91-180 days before stroke) and control periods (equivalent time periods exactly 1 year before stroke) using administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across 10 states from 2016 to 2020. To identify ED treat-and-release visits for a fall and patients hospitalized for acute ischemic stroke, we used previously validated codes. Odds ratios and 95% CIs were calculated using conditional logistic regression.
Among 90 592 hospitalized patients with ischemic stroke, 5230 (5.8%) had an ED treat-and-release visit for a fall within 180 days before their stroke. Patients with an ED treat-and-release visit for a fall were older (mean age, 74.7 [SD, 14.6] versus 70.8 [SD, 15.1] years), more often female (61.9% versus 53.4%), and had higher rates of vascular comorbidities than other patients with stroke. ED treat-and-release visits for a fall were significantly more common in the 15 days before stroke compared with the 15-day control period 1 year earlier (odds ratio, 2.7 [95% CI, 2.4-3.1]). The association between stroke and a preceding ED treat-and-release visit for a fall decreased in magnitude with increasing temporal distance from stroke.
ED treat-and-release visits for a fall are associated with significantly increased short-term ischemic stroke risk. These visits may be opportunities to improve stroke diagnostic accuracy and treatment in the ED.
先前对因缺血性脑卒中而延迟诊断的住院患者的队列研究发现，这些患者的初始急诊诊断通常为跌倒。我们旨在评估因跌倒而在急诊科（即治疗后离院）就诊是否与短期缺血性脑卒中风险增加相关。
本病例交叉设计使用来自 Healthcare Cost and Utilization Project 的行政数据，比较了 2016 年至 2020 年期间 10 个州的所有住院和急诊科就诊病例期（脑卒中前 0-15、16-30、31-90 和 91-180 天）和对照期（与脑卒中前一年的相同时间段）中跌倒所致急诊科就诊的情况。为了识别因跌倒而在急诊科治疗后离院的就诊情况和因急性缺血性脑卒中而住院的患者，我们使用了先前验证的代码。使用条件逻辑回归计算比值比和 95%置信区间。
在 90592 例因缺血性脑卒中而住院的患者中，5230 例（5.8%）在脑卒中前 180 天内因跌倒而在急诊科接受了治疗后离院的治疗。与其他脑卒中患者相比，因跌倒而在急诊科接受治疗后离院的患者年龄更大（平均年龄为 74.7[标准差 14.6] 岁与 70.8[标准差 15.1] 岁），女性比例更高（61.9%与 53.4%），血管合并症的发生率更高。与一年前的 15 天对照期相比，脑卒中前 15 天跌倒所致急诊科就诊的情况更为常见（比值比 2.7[95%CI 2.4-3.1]）。随着与脑卒中时间距离的增加，脑卒中与之前跌倒后在急诊科就诊之间的关联强度逐渐降低。
因跌倒而在急诊科接受治疗后离院与短期缺血性脑卒中风险显著增加相关。这些就诊可能是改善急诊科脑卒中诊断准确性和治疗的机会。
