Background and purpose
For patients with acute ischaemic stroke due to large‐vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than ...medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT‐providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large‐vessel occlusion at a pre‐hospital level, but their predictive value for MT is low. We propose new criteria to identify patients eligible for MT, with higher accuracy.
Methods
The Direct Referral to Endovascular Center criteria were defined based on a retrospective cohort of 317 patients admitted to a stroke center. The association of age, sex, RACE scale score and blood pressure with the likelihood of receiving MT were analyzed. Cut‐off points with the highest association were thereafter evaluated in a prospective cohort of 153 patients from nine stroke units comprising the Madrid Stroke Network.
Results
Patients with a RACE scale score ≥ 5, systolic blood pressure <190 mmHg and age <81 years showed a significantly higher probability of undergoing MT (odds ratio, 33.38; 95% confidence interval, 12–92.9). This outcome was confirmed in the prospective cohort, with 68% sensitivity, 84% specificity, 42% positive and 94% negative predictive values for MT, ruling out 83% of hemorrhagic strokes.
Conclusions
The Direct Referral to Endovascular Center criteria could be useful for identifying patients suitable for MT.
La migraña es una enfermedad incapacitante que se manifiesta con episodios recurrentes de cefalea. El objetivo del estudio fue determinar el coste de la migraña desde la perspectiva de la sociedad en ...España, y caracterizar el exceso de coste debido a la misma.
Se utilizó la Encuesta Europea de Salud en España 2020, obteniéndose 1.442 personas con migraña (77,3% mujeres, 52,5 años) y, mediante emparejamiento óptimo con índice de propensión, 4.288 controles sin migraña (76,7% mujeres, 52,8 años). Se contabilizó utilización de recursos sanitarios y pérdidas de productividad laboral. Los costes se expresaron como coste-anual-por-persona, computándose como exceso el coste diferencial entre personas con y sin migraña.
El coste-anual-por-persona con migraña duplicó al observado en personas sin migraña; 5.862€ vs. 2.981€, con un exceso de 2.881€ (IC95%: 2.410-3.353, p<0,001). El exceso de coste está principalmente representado por el exceso de coste laboral: 1.928€ (1.532-2.325, p<0,001) por persona con migraña/año (66,9% del exceso de coste total), que se explica por un número adicional de días/año de absentismo (22,35 16,12-28,57, p<0,001) y presentismo (31,39 27,36-35,41, p<0,001) en personas con migraña comparado con controles. Un 29,0% del exceso de coste (836€/persona con migraña/año 618-1.055, p<0,001) está representado por costes directos por uso de recursos sanitarios financiados por el Sistema Nacional de Salud (SNS). El impacto económico atribuible a la migraña como resultado de proyectar el exceso de coste a su prevalencia en España podría oscilar entre los 10.394 y 14.230 millones de euros en el año 2020.
En España, las personas con migraña muestran un exceso de coste considerable, particularmente en el coste laboral, en comparación con las personas sin migraña, aunque el coste para el SNS no es desdeñable.
Migraine is a chronic highly disabling disease that manifests itself with recurrent episodes of headache. The objective of the study was to ascertain the cost-of-illness (COI) of migraine from the perspective of Society in Spain and to characterize its excess cost.
The nationwide year-2020 European-Health-Survey-in-Spain was used; 1,442 persons with migraine (77.3% women, 52.5 years) and 4,288 without migraine (76.7% women, 52.8 years) were abstracted by propensity score optimal matching. COI accounted healthcare resources utilization (HRU) and non-HRU (productivity loss). Costs were expressed as Per-Patient-Per-Year (PPPY) in Euros year 2020, and the excess cost was computed as the difference between persons with and without migraine.
The PPPY cost was more than double in persons with migraine; €5,862 vs €2,981; excess cost of €2,881€ (95% CI: 2,410-3,353, p<0.001), mainly attributable to labour productivity loss; €1,928 (1,532-2,325, p<0.001) annually (66.9% of total excess cost). This excess labour cost is explained by the greater number of additional days of absenteeism, 22.35 (16.12; 28.57), and presenteeism, 31.39 (27.36; 35.41) in persons with migraine, p<0.001 in both cases. National Health System (NHS)-funded healthcare PPPY cost represented the 29.0% of total excess cost; €836 (618-1,055), this because higher utilization of all-type medical visits.
In Spain, persons with migraine showed a meaningful excess cost compared with persons without migraine, particularly due to labour cost component, although the economic cost to the NHS was also considerable. Given the high prevalence of migraine, its overall attributable economic impact for Spain might range between 10,394 and 14,230 million Euros in year 2020.
The degree of verbal production necessary to be considered logorrhoea has still not been defined, and no clear correlation has been established between the topography of the dysfunction and this ...symptom.
To provide quantitative data about normal verbal production and to identify the location within the brain of the alterations observed in neuroimage of patients with logorrhoea.
The oral verbal production of 60 control subjects between 20 and 80 years of age was quantified by analysing five speeches. Ten patients who exceeded the 75th percentile in at least two of the five speeches underwent structural and functional neuroimaging tests. RESULTS. The data on verbal production of normal subjects are reported. Age, sex and habits (smoking, coffee, alcoholic drinks) did not exert an influence, but the degree of schooling was seen to have an effect. All the patients were diagnosed with frontotemporal degeneration, although in one case there were also coexisting vascular risk factors and subcortical vascular lesions, which reduce the degree of certainty of the diagnosis. Cortical atrophy is located in the right anterior temporal lobes (100% anteromedial, 100% anteroinferior, 70% anterolateral), left anterior temporal (90% anteromedial, 90% anteroinferior, 60% anterolateral), right prefrontal (30% basal, 50% dorsolateral, 20% medial) and left prefrontal (20% basal, 30% dorsolateral, 20% medial).
Oral verbal production is influenced by level of education and, in a sample of patients with probable frontotemporal degeneration and logorrhoea, all the patients showed alterations in the anteroinferior and anteromedial regions of the right temporal lobe.
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