PMID- 14504322
OWN - NLM
STAT- MEDLINE
DCOM- 20040416
LR  - 20191210
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 61
IP  - 6
DP  - 2003 Sep 23
TI  - VA Stroke Study: neurologist care is associated with increased testing but 
      improved outcomes.
PG  - 792-6
AB  - OBJECTIVE: VA Stroke Study (VASt) data were analyzed to determine whether 
      neurologist management affected the process and outcome of care of patients with 
      ischemic stroke. METHODS: VASt prospectively identified patients with stroke 
      admitted to nine VA hospitals (April 1995 to March 1997). Demographics, stroke 
      severity (Canadian Neurologic Score), stroke subtype (Trial of ORG 10172 in Acute 
      Stroke Treatment [TOAST] classification), tests/procedures, and discharge status 
      (independent, Rankin < or = 2, vs dead or dependent, Rankin 3 through 5) were 
      compared between patients who were or were not cared for by a neurologist. 
      RESULTS: Of 1,073 enrolled patients, 775 (neurologist care, n = 614; 
      non-neurologist, n = 161) with ischemic stroke were admitted from home. Stroke 
      severity (Canadian Neurologic Score 8.7 +/- 0.1 vs 8.4 +/- 0.2; p = 0.44), TOAST 
      subtype (p = 0.55), and patient age (71.4 +/- 0.4 vs 72.4 +/- 0.7; p = 0.23) were 
      similar for neurologists and non-neurologists. Neurologists more frequently 
      obtained MRI (44% vs 16%; p < 0.001), transesophageal echocardiograms (12% vs 2%; 
      p < 0.001), carotid ultrasounds (65% vs 57%; p = 0.05), cerebral angiography (8% 
      vs 1%; p = 0.001), speech (35% vs 18%; p < 0.001), and occupational therapy (46% 
      vs 33%; p = 0.005) evaluations. Brain CT, transthoracic echocardiogram, 24-hour 
      ambulatory ECG use, and hospitalization durations (18.2 +/- 0.8 vs 19.7 +/- 4.1 
      days; p = 0.725) were similar. Neurologists' patients were less likely to be dead 
      (5.6% vs 13.5%; OR = 0.38; 95% CI 0.22, 0.68; p = 0.001) and less likely to be 
      dead or dependent (46.1% vs 57.1%; OR = 0.64; 95% CI 0.45, 0.92; p = 0.019) at 
      the time of discharge. The benefit remained after controlling for stroke severity 
      and comorbidity (OR = 0.63; 95% CI 0.42, 0.94; p = 0.025). CONCLUSION: 
      Neurologist care was associated with more extensive testing, but similar lengths 
      of hospitalization and improved outcomes.
FAU - Goldstein, L B
AU  - Goldstein LB
AD  - Durham VA Medical Center, Durham, NC, USA. golds004@mc.duke.edu
FAU - Matchar, D B
AU  - Matchar DB
FAU - Hoff-Lindquist, J
AU  - Hoff-Lindquist J
FAU - Samsa, G P
AU  - Samsa GP
FAU - Horner, R D
AU  - Horner RD
LA  - eng
GR  - K24 NS02165/NS/NINDS NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
SB  - IM
CIN - Neurology. 2004 May 25;62(10):1914; author reply 1914-5. PMID: 15159518
MH  - Aged
MH  - Cohort Studies
MH  - Diagnostic Imaging/*statistics & numerical data
MH  - Diagnostic Techniques, Neurological/*statistics & numerical data
MH  - Female
MH  - Hospitals, Veterans/*statistics & numerical data
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Neurology/*statistics & numerical data
MH  - Occupational Therapy/statistics & numerical data
MH  - Outcome and Process Assessment, Health Care/*statistics & numerical data
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Speech Therapy/statistics & numerical data
MH  - Stroke/diagnosis/*epidemiology/mortality
MH  - Stroke Rehabilitation
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - United States
EDAT- 2003/09/25 05:00
MHDA- 2004/04/17 05:00
CRDT- 2003/09/25 05:00
PHST- 2003/09/25 05:00 [pubmed]
PHST- 2004/04/17 05:00 [medline]
PHST- 2003/09/25 05:00 [entrez]
AID - 10.1212/01.wnl.0000082724.77447.3a [doi]
PST - ppublish
SO  - Neurology. 2003 Sep 23;61(6):792-6. doi: 10.1212/01.wnl.0000082724.77447.3a.