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Blood pressure accuracy in the hospital
ABSTRACTS
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Hypothyroidism in Ischemic Stroke K. Remmel, Louisville, Kentucky; A. Wannahita, K. Moore, Kentucky
Blood Pressure Accuracy in the Hospital P. Zrelak, D. Cisneros, T. Carter, R. Atkinson, Sacramento, California
Background: Previous studies have demonstrated the importance of hypercholesterolemia and hyperhomocysteinemia as risk factors for stroke. Hypothyroidism has been shown to be associated with hypercholesterolemia and homocysteinemia, but has not been elucidated as a risk factor for stroke. Therefore we studied the association of hypothyroidism in transient ischemic attack (TIA) and ischemic stroke patients. Methods: Patients admitted to the University of Louisville with a diagnosis of TIA or ischemic stroke (IS) between January 2001 and September 2003 were evaluated for stroke risk factors. Subjects underwent stroke work-up which included laboratory evaluations of thyroid stimulating hormone (TSH), lipid panals, and homocysteine (hCys). If TSH was abnormal, further thyroid profiles were obtained. Results: Out of 406 subjects (age range 18 - 95, mean age 68, 205 men) admitted with TIA or ischemic stroke, 305 (75%) had TSH levels recorded. Thirty-three (10.8%) were diagnosed with hThy. Eighteen (54.5%) of these hThy subjects had hyperhCys. HCys level was obtained in 227 (55.9%) of the subjects. Three (9%)of the hThy subjects had hyperhCys. Conclusion: Our data clearly support the association between hThy and TIA or IS. A systematic investigation of stroke risk, comparing hThy to non-hThy subjects, contolling for other known risk factors is needed to further elucidate this relationship.
Background: Decisions in stroke management are dependent on accurate BP measurements. This study evaluated the correlation between standard hospital automated equipment, traditional auscultation, and a reference standard, the Colin Press-mate. Methods: BP measurements were taken on a convenience sample of 59 hospitalized and ED patients. Readings were alternatively taken using the unit standard, a semi-automatic device, and the Colin. During the Colin reading, two RNs using a double-headed stethoscope simultaneously listened and recorded first and fourth Korotkoff sounds. Readings were taken 3 minutes apart in the same arm. A set of sensitivity analyses were performed using dichotomized BP cutoffs ( ⬎185, ⬎140, and ⬎120 mm Hg). Results: There were significant differences in the mean systolic readings among methods (ANOVA: F⫽25.069; P ⬍ .001). This difference remained for all pairs (unadjusted paired t-tests; P ⬍ .01). There were differences in diastolic readings between the unit standard and manual (P ⬍ .03). Although all methods were significantly correlated with each other (range .79-.96; P ⬍ .0001), the unit standard (138.51; 28.58 SD) and manual method (136.36; 28.40 SD) underrated systolic BP compared to the Colin (143/31; 26.97 SD). Significant differences in the regression intercepts further support this bias (intercept 8800 0; P ⱕ .01). All slopes were not significantly different from 1.0 (P ⬎ .05). Sensitivity analyses, limited by sparse data, demonstrated low Se for all groups [(ⱖ120; 77.6 (64-87.6): ⱖ140; 60.7 (42-77): ⱖ185: 42.8 (12-78)] and high Sp [(100.0 (94-100); 96.8 (85-99.8) and 100.0 (94-100)]. False negative rate ranged from 22% to 57%. The likelihood ratios and 95% CI for a negative test were 0.22 (.66-.89), .26 (.11-.62), and 0.57 (0.30-1.09) respectively. Agreement between RNs demonstrated a systematic bias and moderate random variation. Conclusions: There are significant variations in BP determination using automated machines versus auscultation, with a consistent bias toward underrating by the former. The bias towards automated cuff underrating BP in acute ischemic stroke patient can potentially have a significant impact on the treatment and management of the acute stroke patient, particularly in thrombolytic therapy and hemorrhage management.
252 23
24
Hypothyroidism in Ischemic Stroke K. Remmel, Louisville, Kentucky; A. Wannahita, K. Moore, Kentucky
Blood Pressure Accuracy in the Hospital P. Zrelak, D. Cisneros, T. Carter, R. Atkinson, Sacramento, California
Background: Previous studies have demonstrated the importance of hypercholesterolemia and hyperhomocysteinemia as risk factors for stroke. Hypothyroidism has been shown to be associated with hypercholesterolemia and homocysteinemia, but has not been elucidated as a risk factor for stroke. Therefore we studied the association of hypothyroidism in transient ischemic attack (TIA) and ischemic stroke patients. Methods: Patients admitted to the University of Louisville with a diagnosis of TIA or ischemic stroke (IS) between January 2001 and September 2003 were evaluated for stroke risk factors. Subjects underwent stroke work-up which included laboratory evaluations of thyroid stimulating hormone (TSH), lipid panals, and homocysteine (hCys). If TSH was abnormal, further thyroid profiles were obtained. Results: Out of 406 subjects (age range 18 - 95, mean age 68, 205 men) admitted with TIA or ischemic stroke, 305 (75%) had TSH levels recorded. Thirty-three (10.8%) were diagnosed with hThy. Eighteen (54.5%) of these hThy subjects had hyperhCys. HCys level was obtained in 227 (55.9%) of the subjects. Three (9%)of the hThy subjects had hyperhCys. Conclusion: Our data clearly support the association between hThy and TIA or IS. A systematic investigation of stroke risk, comparing hThy to non-hThy subjects, contolling for other known risk factors is needed to further elucidate this relationship.
Background: Decisions in stroke management are dependent on accurate BP measurements. This study evaluated the correlation between standard hospital automated equipment, traditional auscultation, and a reference standard, the Colin Press-mate. Methods: BP measurements were taken on a convenience sample of 59 hospitalized and ED patients. Readings were alternatively taken using the unit standard, a semi-automatic device, and the Colin. During the Colin reading, two RNs using a double-headed stethoscope simultaneously listened and recorded first and fourth Korotkoff sounds. Readings were taken 3 minutes apart in the same arm. A set of sensitivity analyses were performed using dichotomized BP cutoffs ( ⬎185, ⬎140, and ⬎120 mm Hg). Results: There were significant differences in the mean systolic readings among methods (ANOVA: F⫽25.069; P ⬍ .001). This difference remained for all pairs (unadjusted paired t-tests; P ⬍ .01). There were differences in diastolic readings between the unit standard and manual (P ⬍ .03). Although all methods were significantly correlated with each other (range .79-.96; P ⬍ .0001), the unit standard (138.51; 28.58 SD) and manual method (136.36; 28.40 SD) underrated systolic BP compared to the Colin (143/31; 26.97 SD). Significant differences in the regression intercepts further support this bias (intercept 8800 0; P ⱕ .01). All slopes were not significantly different from 1.0 (P ⬎ .05). Sensitivity analyses, limited by sparse data, demonstrated low Se for all groups [(ⱖ120; 77.6 (64-87.6): ⱖ140; 60.7 (42-77): ⱖ185: 42.8 (12-78)] and high Sp [(100.0 (94-100); 96.8 (85-99.8) and 100.0 (94-100)]. False negative rate ranged from 22% to 57%. The likelihood ratios and 95% CI for a negative test were 0.22 (.66-.89), .26 (.11-.62), and 0.57 (0.30-1.09) respectively. Agreement between RNs demonstrated a systematic bias and moderate random variation. Conclusions: There are significant variations in BP determination using automated machines versus auscultation, with a consistent bias toward underrating by the former. The bias towards automated cuff underrating BP in acute ischemic stroke patient can potentially have a significant impact on the treatment and management of the acute stroke patient, particularly in thrombolytic therapy and hemorrhage management.