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Is use of mechanical ventilation a reasonable proxy indicator for coma among Medicare patients hospitalized for acute stroke?
- Source :
-
Health Services Research . Feb1998, Vol. 32 Issue 6, p841-859. 19p. 5 Charts, 1 Graph. - Publication Year :
- 1998
-
Abstract
- <bold>Objective: </bold>To ascertain whether use of mechanical ventilation on admission to the hospital is a proxy indicator of coma (i.e., very severe stroke) among acute stroke patients.<bold>Methods: </bold>A secondary analysis of data from a medical record review on a nationally representative sample of 2,824 Medicare patients, ages 65 years or older, who were hospitalized for stroke in 1982-1983 or 1985-1986 in 297 acute care hospitals in 30 areas within five geographically dispersed states.<bold>Results: </bold>Use of mechanical ventilation on the first day of hospitalization was significantly associated with level of consciousness on admission: < 2 percent of noncomatose patients versus 17.5 percent of comatose (p < .001). With a high specificity and high likelihood ratio for a positive test, use of mechanical ventilation on the first day of hospitalization ruled-in coma. It was also significantly associated with severity of illness, prognostic indicators (i.e., admission through the emergency room, admission to intensive care, and having a "do-not-resuscitate" order written during the hospital stay), and with in-hospital death. Adjusting for patient demographics, stroke type, comorbidity, and process of care, early initiation of mechanical ventilation remained significantly associated with both coma and in-hospital death.<bold>Conclusions: </bold>A stroke patient's use of mechanical ventilation on the first day of hospitalization is a valid proxy indicator of level of consciousness. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CEREBROVASCULAR disease patients
*BRAIN disease treatment
*ARTIFICIAL respiration
*CEREBROVASCULAR disease
*COMA
*COMPARATIVE studies
*HEALTH status indicators
*HOSPITAL admission & discharge
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*MEDICARE
*PATIENTS
*PROGNOSIS
*RESEARCH
*SURVEYS
*TIME
*EVALUATION research
*SEVERITY of illness index
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 00179124
- Volume :
- 32
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Health Services Research
- Publication Type :
- Academic Journal
- Accession number :
- 216800