Biomedical subjects

Nelda M Garcia

Publications and source records attributed to Nelda M Garcia.

3 recordsLinked to original sources

PubMed2006

Defining cause of death in stroke patients: The Brain Attack Surveillance in Corpus Christi Project.

Stroke mortality is an important national health statistic and represents a frequent endpoint for epidemiologic studies. Several methods have been used to determine cause of death after stroke, but their agreement and reliability are unknown. Two hundred consecutive deaths of transient ischemic attack or ischemic stroke patients were identified (January 2000-September 2001) from an ongoing population-based stroke surveillance study in Texas, The Brain Attack Surveillance in Corpus Christi Project. Two neurologists independently recorded the cause of death based on two methods: 1) determining the underlying cause of death as defined by the World Health Organization, and 2) determining whether the death was stroke related. Kappa statistics with 95% confidence intervals were calculated by comparing agreement between methods within reviewers and between reviewers within methods. Agreement between the two cause-of-death-determination methods for each neurologist was 0.41 (95% confidence interval (CI): 0.31, 0.51) and 0.47 (95% CI: 0.38, 0.58), respectively. Agreement between neurologists for the underlying-cause-of-death method was 0.46 (95% CI: 0.32, 0.60); for the stroke-related method, it was 0.63 (95% CI: 0.52, 0.75). Accurate, reliable determinations of cause of death after stroke/transient ischemic attack are not currently feasible. More research is needed to identify a reliable process for coding cause of death from stroke.

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PubMed2004

Stroke risk after transient ischemic attack in a population-based setting.

BACKGROUND AND PURPOSE: Stroke risk after transient ischemic attack (TIA) has not been examined in an ethnically diverse population-based community setting. The purpose of this study was to identify stroke risk among TIA patients in a population-based cerebrovascular disease surveillance project. METHODS: The Brain Attack Surveillance in Corpus Christi (BASIC) Project prospectively ascertains stroke and TIA cases in a geographically isolated Southeast Texas County. The community is approximately half Mexican American and half nonHispanic white. Cases are validated by board-certified neurologists using source documentation. Cumulative risk for stroke after TIA was determined using Kaplan-Meier estimates. Cox proportional hazards regression was used to test for associations between stroke risk after TIA and demographics, symptoms, risk factors, and history of stroke/TIA. RESULTS: BASIC identified 612 TIA cases between January 1, 2000, and December 31, 2002; 60.9% were female and 48.0% were Mexican American. Median age was 73.8 years. Stroke risk within 2 days, 7 days, 30 days, 90 days, and 12 months was 1.64%, 1.97%, 3.15%, 4.03%, and 7.27%, respectively. Stroke risk was not influenced by ethnicity, symptoms, or risk factors. CONCLUSIONS: Using a population-based design, we found that early stroke risk after TIA was less than previously reported in this bi-ethnic population of Mexican Americans and nonHispanic whites. Approximately half of the 90-day stroke risk after TIA occurred within 2 days.

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PubMed2002

Comparison of active and passive surveillance for cerebrovascular disease: The Brain Attack Surveillance in Corpus Christi (BASIC) Project.

To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors compared active surveillance with passive surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive surveillance, 802 were validated to be cerebrovascular events. When passive surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive surveillance for cerebrovascular disease. More uniform surveillance methods would allow comparisons across studies and communities.

Cerebrovascular Disorders↗