Context: Data are limited regarding the risks and benefits of thrombolytic therapy for acute ischemic stroke outside of clinical trials. Abstract:Objective: To investigate predictors of in- hospital mortality in patie...Context: Data are limited regarding the risks and benefits of thrombolytic therapy for acute ischemic stroke outside of clinical trials. Abstract:Objective: To investigate predictors of in- hospital mortality in patients with ischemic stroke treated with intravenous tissue plasminogen activator (tPA) within a pooled analysis of large German stroke registers. Design and Setting: Prospective, observational cohort study conducted at 225 community and academic hospitals throughout Germany cooperating within the German Stroke Registers Study Group. Patients: A total of 1658 patients with acute ischemic stroke who were admitted to study hospitals between 2000 and 2002 and were treated with tPA. Main Outcome Measure: In- hospital mortality. Results: One hundred sixty- six patients (10% ) who received tPA died during hospitalization, with 67.5% of these deaths occurring within 7 days. Factors predicting in- hospital death after tPA use were older age (for each 10- year increment in age, adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3- 1.9) and altered level of consciousness (adjusted OR, 3.4; 95% CI, 2.4- 4.7). The overall rate of symptomatic intracranial hemorrhage was 7.1% and increased with age. One or more serious complications was observed in 27.2% of all patients and in 83.9% of patients who died after tPA treatment. An inverse relation between the number of patients treated with tPA in the respective hospital and the risk of in- hospital death was observed (adjusted OR, 0.97; 95% CI, 0.96- 0.99 for each additional patient treated with tPA per year). Conclusion: In patients with ischemic stroke who are treated with tPA, disturbances of consciousness and increasing age are associated with increased in- hospital mortality.展开更多
Aim: To examine whether symptoms suggestive of infection, health problems, and health care utilisation are risk factors for SIDS. Methods: Matched case-contr ol study with 333 SIDS infants and 998 control infants matc...Aim: To examine whether symptoms suggestive of infection, health problems, and health care utilisation are risk factors for SIDS. Methods: Matched case-contr ol study with 333 SIDS infants and 998 control infants matched for region, age, gender, and reference sleep. Information was obtained by parental interview, pae diatrician completed questionnaire, and hospital admission data. Results: No sym ptoms were associated with SIDS after adjustment for potential confounders. Illn ess in the last four weeks as reported by the paediatrician did not differ betwe en cases and controls. Developmental problems and special investigations at any stage of life significantly increased the risk of SIDS (adjusted OR = 2.14 and 2 .07). Admission to hospital after the first week of life was associated with an increased risk of SIDS (adjusted OR = 1.88). Conclusion: Symptoms of infection a nd illness are no longer risk factors for SIDS in communities such as Germany wh ere few infants sleep prone. The increased risk of SIDS with developmental probl ems may indicate that infants which subsequently die of SIDS are abnormal or in some way vulnerable.展开更多
文摘Context: Data are limited regarding the risks and benefits of thrombolytic therapy for acute ischemic stroke outside of clinical trials. Abstract:Objective: To investigate predictors of in- hospital mortality in patients with ischemic stroke treated with intravenous tissue plasminogen activator (tPA) within a pooled analysis of large German stroke registers. Design and Setting: Prospective, observational cohort study conducted at 225 community and academic hospitals throughout Germany cooperating within the German Stroke Registers Study Group. Patients: A total of 1658 patients with acute ischemic stroke who were admitted to study hospitals between 2000 and 2002 and were treated with tPA. Main Outcome Measure: In- hospital mortality. Results: One hundred sixty- six patients (10% ) who received tPA died during hospitalization, with 67.5% of these deaths occurring within 7 days. Factors predicting in- hospital death after tPA use were older age (for each 10- year increment in age, adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3- 1.9) and altered level of consciousness (adjusted OR, 3.4; 95% CI, 2.4- 4.7). The overall rate of symptomatic intracranial hemorrhage was 7.1% and increased with age. One or more serious complications was observed in 27.2% of all patients and in 83.9% of patients who died after tPA treatment. An inverse relation between the number of patients treated with tPA in the respective hospital and the risk of in- hospital death was observed (adjusted OR, 0.97; 95% CI, 0.96- 0.99 for each additional patient treated with tPA per year). Conclusion: In patients with ischemic stroke who are treated with tPA, disturbances of consciousness and increasing age are associated with increased in- hospital mortality.
文摘Aim: To examine whether symptoms suggestive of infection, health problems, and health care utilisation are risk factors for SIDS. Methods: Matched case-contr ol study with 333 SIDS infants and 998 control infants matched for region, age, gender, and reference sleep. Information was obtained by parental interview, pae diatrician completed questionnaire, and hospital admission data. Results: No sym ptoms were associated with SIDS after adjustment for potential confounders. Illn ess in the last four weeks as reported by the paediatrician did not differ betwe en cases and controls. Developmental problems and special investigations at any stage of life significantly increased the risk of SIDS (adjusted OR = 2.14 and 2 .07). Admission to hospital after the first week of life was associated with an increased risk of SIDS (adjusted OR = 1.88). Conclusion: Symptoms of infection a nd illness are no longer risk factors for SIDS in communities such as Germany wh ere few infants sleep prone. The increased risk of SIDS with developmental probl ems may indicate that infants which subsequently die of SIDS are abnormal or in some way vulnerable.
