Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke

Phyo Kyaw Myint, Andrew C Kidd, Chun Shing Kwok, Stanley D Musgrave, Oliver Redmayne, Anthony K Metcalf, Joseph Ngeh, Anne Nicolson, Peter Owusu-Agyei, Raj Shekhar, Kevin Walsh, Diana J Day, Elizabeth A Warburton, Max O Bachmann, John F Potter, Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

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Abstract

Background Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. Methods We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. Results Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]). Conclusions Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.
Original languageEnglish
Pages (from-to)3005-3012
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume25
Issue number12
Early online date8 Sep 2016
DOIs
Publication statusPublished - Dec 2016

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Stroke
Tomography
Mortality
Odds Ratio
Benchmarking
National Health Programs
Home Care Services
Hospital Mortality
England
Inpatients
Confidence Intervals

Keywords

  • stroke
  • age
  • computerized tomography
  • mortality

Cite this

Myint, P. K., Kidd, A. C., Kwok, C. S., Musgrave, S. D., Redmayne, O., Metcalf, A. K., ... Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group (2016). Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke. Journal of Stroke and Cerebrovascular Diseases, 25(12), 3005-3012. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.020

Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke. / Myint, Phyo Kyaw; Kidd, Andrew C; Kwok, Chun Shing; Musgrave, Stanley D; Redmayne, Oliver; Metcalf, Anthony K; Ngeh, Joseph; Nicolson, Anne; Owusu-Agyei, Peter; Shekhar, Raj; Walsh, Kevin; Day, Diana J; Warburton, Elizabeth A; Bachmann, Max O; Potter, John F; Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 25, No. 12, 12.2016, p. 3005-3012.

Research output: Contribution to journalArticle

Myint, PK, Kidd, AC, Kwok, CS, Musgrave, SD, Redmayne, O, Metcalf, AK, Ngeh, J, Nicolson, A, Owusu-Agyei, P, Shekhar, R, Walsh, K, Day, DJ, Warburton, EA, Bachmann, MO, Potter, JF & Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group 2016, 'Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke', Journal of Stroke and Cerebrovascular Diseases, vol. 25, no. 12, pp. 3005-3012. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.020
Myint, Phyo Kyaw ; Kidd, Andrew C ; Kwok, Chun Shing ; Musgrave, Stanley D ; Redmayne, Oliver ; Metcalf, Anthony K ; Ngeh, Joseph ; Nicolson, Anne ; Owusu-Agyei, Peter ; Shekhar, Raj ; Walsh, Kevin ; Day, Diana J ; Warburton, Elizabeth A ; Bachmann, Max O ; Potter, John F ; Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group. / Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke. In: Journal of Stroke and Cerebrovascular Diseases. 2016 ; Vol. 25, No. 12. pp. 3005-3012.
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abstract = "Background Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. Methods We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. Results Of the 7693 patients (mean age 76.1 years, 50{\%} male) included, 1151 (16{\%}) died as inpatients and 336 (4{\%}) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95{\%} confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]). Conclusions Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.",
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author = "Myint, {Phyo Kyaw} and Kidd, {Andrew C} and Kwok, {Chun Shing} and Musgrave, {Stanley D} and Oliver Redmayne and Metcalf, {Anthony K} and Joseph Ngeh and Anne Nicolson and Peter Owusu-Agyei and Raj Shekhar and Kevin Walsh and Day, {Diana J} and Warburton, {Elizabeth A} and Bachmann, {Max O} and Potter, {John F} and {Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group}",
note = "We gratefully acknowledge the funder of this research, NIHR Research for Patient Benefit Programme. We are also indebted to all the research and clinical teams based at the participating NHS trusts, and the staff from the respective research and development departments. We also would like to thank the Anglia Stroke & Heart Clinical Network for their support.",
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TY - JOUR

T1 - Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke

AU - Myint, Phyo Kyaw

AU - Kidd, Andrew C

AU - Kwok, Chun Shing

AU - Musgrave, Stanley D

AU - Redmayne, Oliver

AU - Metcalf, Anthony K

AU - Ngeh, Joseph

AU - Nicolson, Anne

AU - Owusu-Agyei, Peter

AU - Shekhar, Raj

AU - Walsh, Kevin

AU - Day, Diana J

AU - Warburton, Elizabeth A

AU - Bachmann, Max O

AU - Potter, John F

AU - Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

N1 - We gratefully acknowledge the funder of this research, NIHR Research for Patient Benefit Programme. We are also indebted to all the research and clinical teams based at the participating NHS trusts, and the staff from the respective research and development departments. We also would like to thank the Anglia Stroke & Heart Clinical Network for their support.

PY - 2016/12

Y1 - 2016/12

N2 - Background Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. Methods We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. Results Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]). Conclusions Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.

AB - Background Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. Methods We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. Results Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]). Conclusions Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.

KW - stroke

KW - age

KW - computerized tomography

KW - mortality

U2 - 10.1016/j.jstrokecerebrovasdis.2016.08.020

DO - 10.1016/j.jstrokecerebrovasdis.2016.08.020

M3 - Article

VL - 25

SP - 3005

EP - 3012

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 12

ER -