IMPORTANCE It is uncertain whether coronavirus disease 2019 (COVID-19) is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection. OBJECTIVE To compare the rate of ischemic stroke between patients with COVID-19 and patients with influenza, a respiratory viral illness previously associated with stroke.
BACKGROUND AND PURPOSE: A large spectrum of neurologic disease has been reported in patients with coronavirus disease 2019 (COVID-19) infection. Our aim was to investigate the yield of neuroimaging in patients with COVID-19 undergoing CT or MR imaging of the brain and to describe associated imaging findings. MATERIALS AND METHODS: We performed a retrospective cohort study involving 2054 patients with laboratory-confirmed COVID-19 presenting to 2 hospitals in New York City between March 4 and May 9, 2020, of whom 278 (14%) underwent either CT or MR imaging of the brain. All images initially received a formal interpretation from a neuroradiologist within the institution and were subsequently reviewed by 2 neuroradiologists in consensus, with disputes resolved by a third neuroradiologist. RESULTS: The median age of these patients was 64 years (interquartile range, 50-75 years), and 43% were women. Among imaged patients, 58 (21%) demonstrated acute or subacute neuroimaging findings, the most common including cerebral infarctions (11%), parenchymal hematomas (3.6%), and posterior reversible encephalopathy syndrome (1.1%). Among the 51 patients with MR imaging examinations, 26 (51%) demonstrated acute or subacute findings; notable findings included 6 cases of cranial nerve abnormalities (including 4 patients with olfactory bulb abnormalities) and 3 patients with a microhemorrhage pattern compatible with critical illness-associated microbleeds. CONCLUSIONS: Our experience confirms the wide range of neurologic imaging findings in patients with COVID-19 and suggests the need for further studies to optimize management for these patients. ABBREVIATIONS: ACE2 ¼ angiotensin converting enzyme 2; COVID-19 ¼ coronavirus disease 2019; MFS ¼ Miller Fisher syndrome; PRES ¼ posterior reversible encephalopathy syndrome; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 S ince the introduction of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) to the human population in December 2019, coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic. While pulmonary manifestations remain its hallmark, COVID-19 is gaining recognition as a multisystem disease, 1-6 and there is increasing recognition of frequent neurologic manifestations, which reportedly may affect up to
Background Although federal regulations mandate documentation of structured race data according to Office of Management and Budget (OMB) categories in electronic health record (EHR) systems, many institutions have reported gaps in EHR race data that hinder secondary use for population-level research focused on underserved populations. When evaluating race data available for research purposes, we found our institution's enterprise EHR contained structured race data for only 51% (1.6 million) of patients.
Objectives We seek to improve the availability and quality of structured race data available to researchers by integrating values from multiple local sources.
Methods To address the deficiency in race data availability, we implemented a method to supplement OMB race values from four local sources—inpatient EHR, inpatient billing, natural language processing, and coded clinical observations. We evaluated this method by measuring race data availability and data quality with respect to completeness, concordance, and plausibility.
Results The supplementation method improved race data availability in the enterprise EHR up to 10% for some minority groups and 4% overall. We identified structured OMB race values for more than 142,000 patients, nearly a third of whom were from racial minority groups. Our data quality evaluation indicated that the supplemented race values improved completeness in the enterprise EHR, originated from sources in agreement with the enterprise EHR, and were unbiased to the enterprise EHR.
Conclusion Implementation of this method can successfully increase OMB race data availability, potentially enhancing accrual of patients from underserved populations to research studies.
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