Abstract
Background: The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 394-399 |
| Number of pages | 6 |
| Journal | International Journal of Clinical Practice |
| Volume | 62 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2008 |
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Improved aetiological diagnosis of ischaemic stroke in a Vascular Medicine Unit - The significance of transesophageal echocardiogram. / Martignoni, A.; Sartori, M.; Lanzarini, L.; Negri, M.; Martino, I.; Benedicti, E.; Marchesi, E.; Bertone, G.; Tinelli, C.; Falaschi, F.
In: International Journal of Clinical Practice, Vol. 62, No. 3, 03.2008, p. 394-399.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Improved aetiological diagnosis of ischaemic stroke in a Vascular Medicine Unit - The significance of transesophageal echocardiogram
AU - Martignoni, A.
AU - Sartori, M.
AU - Lanzarini, L.
AU - Negri, M.
AU - Martino, I.
AU - Benedicti, E.
AU - Marchesi, E.
AU - Bertone, G.
AU - Tinelli, C.
AU - Falaschi, F.
PY - 2008/3
Y1 - 2008/3
N2 - Background: The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.
AB - Background: The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.
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UR - http://www.scopus.com/inward/citedby.url?scp=38849124176&partnerID=8YFLogxK
U2 - 10.1111/j.1742-1241.2007.01672.x
DO - 10.1111/j.1742-1241.2007.01672.x
M3 - Article
C2 - 18261074
AN - SCOPUS:38849124176
VL - 62
SP - 394
EP - 399
JO - International Journal of Clinical Practice
JF - International Journal of Clinical Practice
SN - 1368-5031
IS - 3
ER -