Social History Matters–The Impact of Illicit Drug Use on tPA Use and In-Hospital Mortality in Acute Ischemic Stroke
Matthew H. M. Marx, Karen C. Albright, Amir Shaban, Amelia K. Boehme, T. Mark Beasley, Sheryl Martin-Schild
International Neuropsychiatric Disease Journal · pp. 127–135 · Published 7 Feb 2014
10.9734/INDJ/2014/7708Abstract
Aims: The objective of this descriptive study was to compare time to medical evaluation, intravenous tissue plasminogen activator (IV tPA) use, and short-term outcomes in illicit drug users compared to non-users presenting with acute ischemic stroke (AIS). Study Design: This is a retrospective study performed from our stroke registry using de-identified patient information. Place and Duration of Study: Tulane Medical Center Primary Stroke Center (PSC). Consecutive AIS patients presenting to our PSC from July 2008 to December of 2010 were identified from our prospectively collected stroke registry. Methodology: Patients were categorized as toxicology positive (TP) or toxicology negative (TN). We compared baseline characteristics, clinical presentation, tPA use, and short-term outcomes in TP and TN patients. Results: Two hundred and sixty-three patients met inclusion criteria (median age 63, 35.4% female, 66.5% Black). Nearly 40% of toxicology screens were positive. Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; however, a higher proportion of TN patients were treated with IV tPA (32.1% vs. 21.2%). After adjustment for time from last seen normal to emergency department arrival (LSN-to-ED arrival), the odds of being treated with tPA for TP patients were similar to TN patients (OR 0.69, 95% CI 0.36-1.31, p=0.255). After adjustment for age, NIHSS, glucose, and tPA, the odds of in-hospital mortality in TP patients was 3 times that of TN patients (OR 3.17, 95% CI 1.07-9.43, p=0.038). Conclusion: We found that the disparities observed in tPA use were attenuated after adjustment for time from LSN-to-ED arrival, suggesting an area for future intervention. Additionally, we found that TP patients may be at higher risk for in-hospital mortality. Further study on the role of substance abuse in time to ED arrival, tPA use, and outcome in AIS patients is warranted.
References (8)
- 1 Adjusting for multiple testing—when and how? [DOI]
- 2 Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard [DOI]
- 3 Trends in Substance Abuse Preceding Stroke Among Young Adults [DOI]
- 4 Reasons for exclusion from thrombolytic therapy following acute ischemic stroke [DOI]
- 5 Reasons for exclusion from thrombolytic therapy following acute ischemic stroke [DOI]
- 6 The dissonant care management of illicit drug users in medical wards, the views of nurses and patients: a grounded theory study [DOI]
- 7 Urine toxicology screening in an urban stroke and TIA population [DOI]
- 8 Manual for Primary Care Providers: Effectively Caring for Active Substance Users
Cited by 8
Tormoehlen LM, Blatsioris AD, Moser EA · Neurology · 2017
G. Al Dandachi, S. Montagnon, P. Plaisance · Journal Européen des Urgences et de Réanimation · 2015
Hamed Mirzaei · Journal of Cellular Biochemistry · 2017
Laura M. Tormoehlen, Ashley D. Blatsioris, Elizabeth A.S. Moser · Neurology · 2017
Showing 4 of 8 known citations — external sources report more than can currently be individually listed.
Related research
- An Overview of Drug Abuse: Causes, Effects, and Control Measures — shares topic coverage
- Youth and Drugs: Problems, Consequences and Preventives Measures — shares topic coverage
- The Practice of Cramming among Pre-Clinical Medical Students and Their Remedial Examination Result: A Simple Preliminary Demographic Analysis — shares topic coverage
- Perception of Youth about Substance Abuse: The Case of Ghanaian Youth on Alcohol Usage — shares topic coverage
- Substance Abuse among Residents of Gwagwalada Abuja, Nigeria — shares topic coverage
Article metrics
Real usage data collected on this platform.
21
Page views
0
PDF downloads
10
Outbound clicks
8
Citations
Views over time
Views by country
Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".
Traffic sources
Referring site, by host.
Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.