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Brett Kissela

Publications and source records attributed to Brett Kissela.

23 records · Page 2Linked to original sources
PubMed2004

Eligibility for recombinant tissue plasminogen activator in acute ischemic stroke: a population-based study.

BACKGROUND AND PURPOSE: Acute ischemic stroke patients are infrequently treated with recombinant tissue plasminogen activator (rtPA). We present unique population-based data regarding the eligibility of ischemic stroke patients for rtPA treatment. METHODS: All ischemic strokes presenting to an emergency department (ED) within a biracial population of 1.3 million were identified. The patient was considered eligible for rtPA on the basis of exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial. RESULTS: Of 2308 ischemic strokes, 1849 presented to an ED. Only 22% of all ischemic strokes in the population arrived in the ED in <3 hours from symptom onset; of these, 209 (51%) were ineligible for rtPA on the basis of mild stroke severity, medical and surgical history, or blood tests. CONCLUSIONS: In our population in 1993 to 1994, 8% of all ischemic stroke patients presented to an ED within 3 hours and met other eligibility criteria for rtPA. Even if time were not an exclusion for rtPA, only 29% of all ischemic strokes in our population would have otherwise been eligible for rtPA.

Acute Disease↗
PubMed2004

Stroke in a biracial population: the excess burden of stroke among blacks.

BACKGROUND AND PURPOSE: Excess mortality resulting from stroke is an important reason why blacks have higher age-adjusted mortality rates than whites. This observation has 2 possible explanations: Strokes occur more commonly among blacks or blacks have higher mortality rates after stroke. Our population-based epidemiological study is set in the Greater Cincinnati/Northern Kentucky region of 1.31 million people, which is representative of the US white and black populations with regard to many demographic and socioeconomic characteristics. METHODS: Hospitalized cases were ascertained by International Classification of Diseases (ninth revision) discharge codes, prospective screening of emergency department admission logs, and review of coroner's cases. A sampling scheme was used to ascertain cases in the out-of-hospital setting. All potential cases underwent detailed chart abstraction by study nurses, followed by physician review. Race-specific incidence and case fatality rates were calculated. RESULTS: We identified 3136 strokes during the study period (January 1, 1993, to June 30, 1994). Stroke incidence rates were higher for blacks at every age, with the greatest risk (2- to 5-fold) seen in young and middle-aged blacks (<65 years of age). Case fatality rates did not differ significantly in blacks compared with whites. Applying the resulting age- and race-specific rates to the US population in 2002, we estimate that 705,000 to 740,000 strokes have occurred in the United States, with a minimum of 616,000 cerebral infarctions, 67,000 intracerebral hemorrhages, and 22,000 subarachnoid hemorrhages. CONCLUSIONS: Excess stroke-related mortality in blacks is due to higher stroke incidence rates, particularly in the young and middle-aged. This excess burden of stroke incidence among blacks represents one of the most serious public health problems facing the United States.

Adult↗
PubMed2003

Trends in community knowledge of the warning signs and risk factors for stroke.

CONTEXT: Poor public knowledge of stroke warning signs and risk factors limits effective stroke intervention and prevention. OBJECTIVE: To examine temporal trends in public knowledge of stroke warning signs and risk factors. DESIGN AND SETTING: Population-based random-digit telephone survey conducted in July-November 2000 among individuals in the greater Cincinnati, Ohio, region. PARTICIPANTS: A total of 2173 survey respondents (69% response rate) were randomly identified based on their demographic similarities to the ischemic stroke population with regard to age, race, and sex. MAIN OUTCOME MEASURES: Spontaneous recall of at least 1 important stroke warning sign and 1 established stroke risk factor in comparison with findings from the same survey in 1995. RESULTS: In 2000, 70% of respondents correctly named at least 1 established stroke warning sign vs 57% in 1995 (P<.001), and 72% correctly named at least 1 established stroke risk factor vs 68% in 1995. Groups of individuals with the highest risk and incidence of stroke, such as persons at least 75 years old, blacks, and men, were the least knowledgeable about warning signs and risk factors. Television was the most frequently cited source of knowledge, 32% in 2000 vs 24% in 1995 (P<.001). CONCLUSIONS: Public knowledge of stroke warning signs within the greater Cincinnati region has significantly improved from 1995 to 2000, although knowledge of stroke risk factors did not improve significantly during the same time period. Public education efforts must continue and should focus on groups at the highest risk of stroke.

Adult↗
PubMedDate not supplied

Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome.

BACKGROUND: Nonaneurysmal perimesencephalic subarachnoid hemorrhage (PMSAH) appears to have an etiology and natural history distinct from aneurysm rupture. Referral-based studies suggest that 15% of SAH patients have no discernable cause of bleeding, but the incidence of PMSAH is unknown. We describe the first population-based study of PMSAH and place it in the context of all non-traumatic SAH, with presentation of incidence rates, patient demographics, and clinical outcomes. METHODS: All patients age >/= 18 hospitalized with first-ever, non-traumatic SAH in the Greater Cincinnati area were identified from 5/98-7/01 and 8/02-4/04. PMSAH was defined as hemorrhage restricted to the cisterns surrounding the brainstem and suprasellar cistern and a negative cerebral angiogram. Incidence rates were age, race, and sex adjusted to the 2000 US population. RESULTS: There were 431 SAHs identified. Cases in Asian-Americans (2) were excluded, leaving 429 SAHs for analysis. Of these patients, 77 did not have angiograms. Among remaining cases, 285 had aneurysm rupture, 43 had nonaneurysmal hemorrhage not of the PMSAH pattern, and 24 had PMSAH. The overall annual incidence rates for SAH and PMSAH were 8.7 (95% CI 7.9-9.5) and 0.5 (95% CI 0.3-0.7) per 100,000 persons age >/= 18. Patients with PMSAH were younger (p = 0.018) and less likely to be female (p = 0.020) or hypertensive (p = 0.005) than other SAH patients. There was one death among PMSAH patients during 14 months mean follow-up. CONCLUSIONS: PMSAH represents approximately 5% of all SAH. Its risk factors and outcome differ from other forms of SAH.

Journal Article↗