Abelemborg9911

BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a medical emergency that requires rapid identification and focused assessment early to ensure the best possible outcomes. The purpose of this study is to evaluate the associations between system and patient factors and emergency department (ED) length of stay and in-hospital mortality in patients given a diagnosis of ICH. METHODS A sample of 3108 ICH patients was selected from a statewide administrative database for cross-sectional retrospective analysis. System characteristic (hospital stroke certification), patient characteristics (age, sex, and race), and covariate conditions (stroke severity and comorbidities) were analyzed using descriptive statistics and hierarchical logistic regression models to address the study questions. RESULTS The mean ED length of stay is 2.9 ± 3 hours (range, 0-42 hours) before admission to an inpatient unit. Inpatient mortality is 14.9%. Stroke center certification (P < .000) and stroke severity (P ≤ .000) are signifage, stroke severity, and ED length of stay as predictors of in-hospital mortality for ICH patients. The importance of timely admission to an inpatient unit is emphasized. Optimal systems of care and expedited inpatient admission are vital to reduce morbidity and mortality for ICH stroke patients.

BACKGROUND High-dose prednisone and prednisolone have been increasingly studied as a lower-cost alternative to adrenocorticotropic hormone for the treatment of infantile spasms, but this treatment has not been well studied in children with infantile spasms due to perinatal stroke. METHODS We identified a girl with new-onset infantile spasms due to presumed perinatal left middle cerebral artery stroke seen in our hospital's pediatric stroke clinic in 2019. RESULTS This girl developed infantile spasms at 9 months old. She had right hemiplegic cerebral palsy due to her perinatal stroke but had been otherwise previously healthy. Modified hypsarrhythmia was confirmed on prolonged video-electroencephalography. High-dose prednisolone at 8 mg/kg per day was initiated on the sixth day of spasms. She was treated with this dose for 2 weeks and then tapered over 5 weeks. The girl became seizure-free after receiving her first dose of prednisolone and experienced no significant adverse effects during therapy. Routine ele healthy. Modified hypsarrhythmia was confirmed on prolonged video-electroencephalography. High-dose prednisolone at 8 mg/kg per day was initiated on the sixth day of spasms. She was treated with this dose for 2 weeks and then tapered over 5 weeks. The girl became seizure-free after receiving her first dose of prednisolone and experienced no significant adverse effects during therapy. Routine electroencephalography after completion of prednisolone taper confirmed resolution of modified hypsarrhythmia and no epileptiform discharges. She continued to make excellent development progress during and after treatment. CONCLUSION This case suggests high-dose prednisolone could be considered for first-line therapy for children with infantile spasms due to perinatal stroke; further study is needed.

BACKGROUND Reports regarding prevalence of post-traumatic brain injury (TBI) cognitive deficits were inconsistent. We aimed to synthesize the prevalence of cognitive deficits after TBI in the acute, subacute, and chronic phases. METHODS PubMed, EMBASE, and ProQuest Dissertations and Theses A&I databases were searched from the inception to April 27, 2020. Studies with prospective, retrospective, and cross-sectional designs reporting the prevalence of cognitive deficits after TBI in adults were included. RESULTS A total of 15 articles were included for prevalence estimation. The pooled prevalence of memory and attention deficits after mild TBI was 31% and 20% in the acute phase and 26% and 18% in the subacute phase, respectively, and 49% and 54% in the subacute phase and 21% and 50% in the chronic phase after moderate-to-severe TBI. The overall prevalence of information processing speed deficits after mild TBI in the acute and subacute phases was 21% and 17%, respectively, and 57% in the chronic phase aftTBI was 31% and 20% in the acute phase and 26% and 18% in the subacute phase, respectively, and 49% and 54% in the subacute phase and 21% and 50% in the chronic phase after moderate-to-severe TBI. The overall prevalence of information processing speed deficits after mild TBI in the acute and subacute phases was 21% and 17%, respectively, and 57% in the chronic phase after moderate-to-severe TBI. The overall prevalence of executive dysfunction in the subacute and chronic phases was 48% and 38%, respectively, after moderate-to-severe TBI. CONCLUSION Cognitive deficits are prevalent in the acute to chronic phases after TBI. Healthcare providers should design effective intervention targeting cognitive impairment after TBI as early as possible.

BACKGROUND Significant others of older persons with traumatic brain injury (TBI) may be more likely to face increased caregiving responsibilities, leading to increased relationship challenges. Relatively little is known about this cohort. The study aimed to describe the impact of experiencing a mild/moderate TBI on the older adult as well as the significant other in the year post injury. DESIGN AND METHODS This is a multiple-case study using data from a larger parent study. Qualitative content analysis of interviews conducted at 1, 3, 6, and 12 months post injury with 3 dyads was performed (24 interviews) and included cross-case and cross-time comparisons. RESULTS Dyads that included persons 65 years and older with a mild-moderate TBI and their significant others were enrolled (N = 3/6 individuals). selleck kinase inhibitor The identified themes were struggling to accept limitations and acceptance, gratitude, fear and concern, frustration/anger/guilt/resentment, broader social support, emotional coping, and the presence or absence t groups and case management models for both patients after TBI and their significant others.

Previous research has suggested an association between plagiocephaly and developmental delay. However, study samples drawn from children seen in subspecialty clinics increase the potential for selection and referral bias. Our study evaluates the association between plagiocephaly and developmental delay and the timing of these diagnoses in a primary care setting, where plagiocephaly is commonly diagnosed and managed.

Our retrospective analysis used electronic medical record data from 45 primary care sites within a children's health system from 1999 to 2017, including children aged 0 to 5 years with diagnoses determined by physician diagnosis codes at primary care visits. Children were classified in the plagiocephaly group if diagnosis occurred by 12 months of age. Primary outcome was any developmental delay. Pearson χ2 test, Fisher exact test, and logistic regression analyses were conducted, with multivariable models adjusted for sex, race, ethnicity, insurance, prematurity status (22-36 weeks' gestation), primary care sites, birth year, and diagnoses of abnormal tone and torticollis.