New research was presented at AAN 2015, the American Academy of Neurology’s annual meeting, from April 18 to 25 in Washington, DC. The features below highlight some of the studies that emerged from the conference.
LOS & Return ED Visits in Stroke Patients
The Particulars: The initial hospitalization for patients with acute, mild ischemic stroke can impact long-term outcomes. However, few studies have assessed whether hospital length of stay (LOS) is related to clinical characteristics, in-hospital care processes, and long-term clinical outcomes in this patient population.
Data Breakdown: For a study, adults diagnosed with acute ischemic stroke were grouped according to their LOS. Despite no significant differences between patients, researchers found that inpatient therapy evaluations took place later in those with a LOS longer than 1 day. Patients with an LOS longer than 1 day were more likely to return to the ED within 1 year.
Take Home Pearls: Among ischemic stroke patients, time to therapy evaluation appears to be associated with LOS and risk for return ED visits. Coordination of inpatient care processes, along with assessment and treatment of comorbidities, may impact hospital LOS.
Mental Illness, Substance Abuse, & Children
The Particulars: Understanding outcomes among groups of patients at higher risk of primary and medication-induced psychiatric illness, such as those with neurological conditions, may help reduce the burden of mental illness.
Data Breakdown: Study investigators compared mental health and substance abuse diagnosis patterns and length of stay (LOS) in children with epilepsy, cerebral palsy, and Tourette syndrome with those of the general pediatric population. Depression was the most common psychiatric diagnosis in the general population as well as those with epilepsy and children with cerebral palsy. Children in the general population were more likely than those with neurological conditions to be hospitalized for suicide attempts, suicidal ideation, or substance abuse. Children with neurological conditions had prolonged LOS.
Take Home Pearls: Children with common neurological conditions appear to have specific patterns of hospitalization for mental illness and substance abuse. Disease-specific screening and treatment may help reduce such hospitalizations in these children.
Understanding PD-Related Hospitalizations
The Particulars: Patients with Parkinson’s disease (PD) are at higher risk for emergency room visits and hospitalizations when compared with the general population. However, the prevalence of PD hospital encounters over time has not been well defined.
Data Breakdown: Researchers analyzed data for more than 7,000 patients with PD over 5 years. They found that the rate of hospital encounters increased from 25.6% to 38.5% over the study period. Factors associated with hospital encounters included the number of comorbidities, disease stage, mobility, prior deep brain stimulation, levodopa use, and multi-dimensional caregiver strain index score.
Take Home Pearl: Patients with PD appear to have a high risk for hospitalization and several factors appear to be associated with hospitalization and re-hospitalization.
Comparing Diagnostics in TIA Patients
The Particulars: Evidence indicates that CT is often performed as an initial evaluation prior to MRI despite current guidelines recommending MRI only. The utility of MRI alone versus CT plus MRI in the evaluation of transient ischemic attack (TIA) has not been well defined.
Data Breakdown: For a study, cases of adults with suspected TIA were compared based on those who received CT and MRI and those believed to be at low risk for intracranial hemorrhage who underwent MRI only. Underlying intracranial hemorrhage was not found in either group. No differences were observed in those with or without headache, hypertension, neurologic symptoms, or anticoagulation who received MRI only.
Take Home Pearl: The use of MRI only, as opposed to CT plus MRI, appears to be a safe imaging option for patients with suspected TIA and is associated with a low risk for intracranial hemorrhage.
Driving After Loss of Consciousness
The Particulars: Anecdotal evidence suggests that legal restrictions on driving after episodic losses of consciousness are not well known or communicated by physicians to patients.
Data Breakdown: To assess physician counseling about driving restrictions after non-seizure loss of consciousness, researchers conducted a survey of physicians based on hypothetical cases of transient loss of consciousness. All respondents were less likely to restrict driving after a loss of consciousness than after an epileptic seizure. Those who would counsel against driving were more likely to be aware of and have had previous training about driving restrictions across all loss of consciousness scenarios.
Take Home Pearls: Physicians appear to under-recognize the need to discuss legal driving restrictions with patients following a loss of consciousness. Training about these restrictions may improve communication with patients.
LOS & Return ED Visits in Stroke Patients
The Particulars: The initial hospitalization for patients with acute, mild ischemic stroke can impact long-term outcomes. However, few studies have assessed whether hospital length of stay (LOS) is related to clinical characteristics, in-hospital care processes, and long-term clinical outcomes in this patient population.
Data Breakdown: For a study, adults diagnosed with acute ischemic stroke were grouped according to their LOS. Despite no significant differences between patients, researchers found that inpatient therapy evaluations took place later in those with an LOS longer than 1 day. Patients with an LOS longer than 1 day were more likely to return to the ED within 1 year.
Take Home Pearls: Among ischemic stroke patients, time to therapy evaluation appears to be associated with LOS and risk for return ED visits. Coordination of inpatient care processes, along with assessment and treatment of comorbidities, may impact hospital LOS.
