Electronic Health Data Predict Outcomes After Aneurysmal Subarachnoid Hemorrhage

Zafar, Sahar F.; Postma, E N; Biswal, Siddharth; Fleuren, Lucas M.; Boyle, Emily J.; Bechek, Sophia; O’Connor, Kathleen L.; Shenoy, Abhishek; Jonnalagadda, Durga; Kim, Jennifer; Shafi, Mouhsin; Patel, Aman B.; Rosenthal, Eric S.; Westover, M. Brandon

doi:10.1007/s12028-017-0466-8

Cited by 27 publications

(26 citation statements)

References 39 publications

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“…Even after adjusting for EA burden, age, gender, illness severity and other known predictors of outcome (including HH, APACHE II, DCI, HAP) (Witsch et al., 2016; Zafar et al ., 2017), there was no significant difference in outcomes between patients with EAs treated with AEDs compared to those who were not (OR 0.9 [0.2–3.3], p=0.899).…”

Section: Resultsmentioning

confidence: 99%

“…However the study was underpowered (sample size of 68), and did not evaluate post-discharge outcomes or perform detailed analysis of periodic vs. rhythmic patterns (Crepeau et al ., 2013). Our study goes beyond these existing studies as we performed a more detailed analysis of EEG patterns using the ACNS criteria and a more robust analysis adjusting for additional known predictors of outcome (Witsch et al., 2016; Zafar et al ., 2017). …”

Section: Discussionmentioning

confidence: 99%

“…Our outcome measure was the 3-month Glasgow Outcome Scale (GOS); GOS 1: death; GOS 2: vegetative state; GOS 3: severe disability; GOS 4: moderate disability; GOS 5: good recovery (Jennett, Bond 1975). GOS was abstracted from physician and physical therapy clinical examinations within 3 months of discharge following an established protocol described in prior work (Zafar et al ., 2017). For analysis we dichotomized outcomes into poor (GOS 1–3) vs. good (GOS 4–5).…”

Section: Methodsmentioning

confidence: 99%

“…Significance was set at 0.05, and 2-sided P values are reported. Multivariate analysis was performed using a logistic regression model to assess the association (odds ratios) between EA burden and poor outcome, and to adjust for other covariates believed to contribute to poor outcomes (Witsch et al., 2016; Zafar et al ., 2017). Odds ratios are presented with 95% confidence intervals as OR [95%CI].…”

Section: Methodsmentioning

confidence: 99%

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Effect of epileptiform abnormality burden on neurologic outcome and antiepileptic drug management after subarachnoid hemorrhage

Zafar

Postma

Biswal

et al. 2018

Clinical Neurophysiology

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Effect of epileptiform abnormality burden on neurologic outcome and antiepileptic drug management after subarachnoid hemorrhage

Zafar

Postma

Biswal

et al. 2018

Clinical Neurophysiology

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“…[ 1 2 ] Factors predicting poor outcome include blood pressure variability (BPV)[ 3 4 5 6 7 ] and the need for invasive mechanical ventilation (MV). [ 8 ] BPV is defined as the average of absolute differences between consecutive blood pressure measurements (successive variations of blood pressure [BP SV ]) or variations in blood pressure during a period of time (standard deviation [BP SD ]) or coefficient of variation (BP CV ). [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

Sedation patterns and hyperosmolar therapy in emergency departments were associated with blood pressure variability and outcomes in patients with spontaneous intracranial hemorrhage

Nguyen

Pope

Capobianco

et al. 2020

J Emerg Trauma Shock

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Background: Spontaneous intracranial hemorrhage (sICH) is associated with high mortality. Little information exists to guide initial resuscitation in the emergency department (ED) setting. However, blood pressure variability (BPV) and mechanical ventilation (MV) are known risk factors for poor outcome in sICH. Objectives: The objective was to examine the associations between BPV and MV in ED (EDMV) and between two ED interventions – post-MV sedation and hyperosmolar therapy for elevated intracranial pressure – and BPV in the ED and in-hospital mortality. Methods: We retrospectively studied adults with sICH and external ventricular drainage who were transferred to a quaternary academic medical center from other hospitals between January 2011 and September 2015. We used multivariable linear and logistic regressions to measure associations between clinical factors, BPV, and outcomes. Results: We analyzed ED records from 259 patients. There were 143 (55%) EDMV patients who had more severe clinical factors and significantly higher values of all BPV indices than NoEDMV patients. Two clinical factors and none of the severity scores (i.e., Hunt and Hess, World Federation of Neurological Surgeons Grades, ICH score) correlated with BPV. Hyperosmolarity therapy without fluid resuscitation positively correlated with all BPV indices, whereas propofol infusion plus a narcotic negatively correlated with one of them. Two BPV indices, i.e., successive variation of blood pressure (BP SV ) and absolute difference in blood pressure between ED triage and departure (BP Depart − Triage ), were significantly associated with increased mortality rate. Conclusion: Patients receiving MV had significantly higher BPV, perhaps related to disease severity. Good ED sedation, hyperosmolar therapy, and fluid resuscitation were associated with less BPV and lower likelihood of death.

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Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures

Zafar,

Sivaraju,

Rubinos

et al. 2024

JAMA Neurol

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ImportanceAntiseizure medications (ASMs) are frequently prescribed for acute symptomatic seizures and epileptiform abnormalities (EAs; eg, periodic or rhythmic patterns). There are limited data on factors associated with ASM use and their association with outcomes.ObjectivesTo determine factors associated with ASM use in patients with confirmed or suspected acute symptomatic seizures undergoing continuous electroencephalography, and to explore the association of ASMs with outcomes.Design, Setting, and ParticipantsThis multicenter cohort study was performed between July 1 and September 30, 2021, at 5 US centers of the Post Acute Symptomatic Seizure Investigation and Outcomes Network. After screening 1717 patients, the study included 1172 hospitalized adults without epilepsy who underwent continuous electroencephalography after witnessed or suspected acute symptomatic seizures. Data analysis was performed from November 14, 2023, to February 2, 2024.ExposureASM treatment (inpatient ASM continuation ≥48 hours).Main Outcomes and MeasuresFactors associated with (1) ASM treatment, (2) discharge ASM prescription, and (3) discharge and 3-month Glasgow Outcome Scale score of 4 or 5 were ascertained.ResultsA total of 1172 patients (median [IQR] age, 64 [52-75] years; 528 [45%] female) were included. Among them, 285 (24%) had clinical acute symptomatic seizures, 107 (9%) had electrographic seizures, and 364 (31%) had EAs; 532 (45%) received ASM treatment. Among 922 patients alive at discharge, 288 (31%) were prescribed ASMs. The respective frequencies of inpatient ASM treatment and discharge prescription were 82% (233 of 285) and 69% (169 of 246) for patients with clinical acute symptomatic seizures, 96% (103 of 107) and 95% (61 of 64) for electrographic seizures, and 64% (233 of 364) and 48% (128 of 267) for EAs. On multivariable analysis, acute and progressive brain injuries were independently associated with increased odds of inpatient ASM treatment (odds ratio [OR], 3.86 [95% CI, 2.06-7.32] and 8.37 [95% CI, 3.48-20.80], respectively) and discharge prescription (OR, 2.26 [95% CI, 1.04-4.98] and 10.10 [95% CI, 3.94-27.00], respectively). Admission to the neurology or neurosurgery service (OR, 2.56 [95% CI, 1.08-6.18]) or to the neurological intensive care unit (OR, 7.98 [95% CI, 3.49-19.00]) was associated with increased odds of treatment. Acute symptomatic seizures and EAs were significantly associated with increased odds of ASM treatment (OR, 14.30 [95% CI, 8.52-24.90] and 2.30 [95% CI, 1.47-3.61], respectively) and discharge prescription (OR, 12.60 [95% CI, 7.37-22.00] and 1.72 [95% CI, 1.00-2.97], respectively). ASM treatment was not associated with outcomes at discharge (OR, 0.96 [95% CI, 0.61-1.52]) or at 3 months after initial presentation (OR, 1.26 [95% CI, 0.78-2.04]). Among 623 patients alive and with complete data at 3 months after discharge, 30 (5%) had postdischarge seizures, 187 (30%) were receiving ASMs, and 202 (32%) had all-cause readmissions.Conclusions and RelevanceThis study suggests that etiology and electrographic findings are associated with ASM treatment for acute symptomatic seizures and EAs; ASM treatment was not associated with functional outcomes. Comparative effectiveness studies are indicated to identify which patients may benefit from ASMs and to determine the optimal treatment duration.

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Electronic Health Data Predict Outcomes After Aneurysmal Subarachnoid Hemorrhage

Cited by 27 publications

References 39 publications

Effect of epileptiform abnormality burden on neurologic outcome and antiepileptic drug management after subarachnoid hemorrhage

Effect of epileptiform abnormality burden on neurologic outcome and antiepileptic drug management after subarachnoid hemorrhage

Sedation patterns and hyperosmolar therapy in emergency departments were associated with blood pressure variability and outcomes in patients with spontaneous intracranial hemorrhage

Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures

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