Cargando…

An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings

BACKGROUND: Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergen...

Descripción completa

Detalles Bibliográficos
Autores principales: Irisawa, Taro, Iwami, Taku, Kitamura, Tetsuhisa, Nishiyama, Chika, Sakai, Tomohiko, Tanigawa-Sugihara, Kayo, Hayashida, Sumito, Nishiuchi, Tatsuya, Shiozaki, Tadahiko, Tasaki, Osamu, Kawamura, Takashi, Hiraide, Atsushi, Shimazu, Takeshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878578/
https://www.ncbi.nlm.nih.gov/pubmed/24341562
http://dx.doi.org/10.1186/1471-227X-13-24
_version_ 1782297833779494912
author Irisawa, Taro
Iwami, Taku
Kitamura, Tetsuhisa
Nishiyama, Chika
Sakai, Tomohiko
Tanigawa-Sugihara, Kayo
Hayashida, Sumito
Nishiuchi, Tatsuya
Shiozaki, Tadahiko
Tasaki, Osamu
Kawamura, Takashi
Hiraide, Atsushi
Shimazu, Takeshi
author_facet Irisawa, Taro
Iwami, Taku
Kitamura, Tetsuhisa
Nishiyama, Chika
Sakai, Tomohiko
Tanigawa-Sugihara, Kayo
Hayashida, Sumito
Nishiuchi, Tatsuya
Shiozaki, Tadahiko
Tasaki, Osamu
Kawamura, Takashi
Hiraide, Atsushi
Shimazu, Takeshi
author_sort Irisawa, Taro
collection PubMed
description BACKGROUND: Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergency medical service (EMS) and diagnosis of stroke among impaired consciousness patients. METHODS: We included all patients aged 18 years or older who were treated and transported by EMS, and had impaired consciousness (Japan Coma Scale ≧ 1) in Osaka City (2.7 million), Japan from January 1, 1998 through December 31, 2007. Data were prospectively collected by EMS personnel using a study-specific case report form. Multiple logistic regressions assessed the relationship between initial SBP and stroke and its subtypes adjusted for possible confounding factors. RESULTS: During these 10 years, a total of 1,840,784 emergency patients who were treated and transported by EMS were documented during the study period in Osaka City. Out of 128,678 with impaired consciousness, 106,706 who had prehospital SBP measurements in the field were eligible for our analyses. The proportion of patients with severe impaired consciousness significantly increased from 14.5% in the <100 mmHg SBP group to 27.6% in the > =200 mmHg SBP group (P for trend <0.001). The occurrence of stroke significantly increased with increasing SBP (adjusted odd ratio [AOR] 1.34, 95% confidence interval [CI] 1.33 to 1.35), and the AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 5.26 (95% CI 4.93 to 5.60). The AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 9.76 in subarachnoid hemorrhage (SAH), 16.16 in intracranial hemorrhage (ICH), and 1.52 in ischemic stroke (IS), and the AOR of SAH and ICH was greater than that of IS. CONCLUSIONS: Elevated SBP among emergency patients with impaired consciousness in the field was associated with increased diagnosis of stroke.
format Online
Article
Text
id pubmed-3878578
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-38785782014-01-03 An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings Irisawa, Taro Iwami, Taku Kitamura, Tetsuhisa Nishiyama, Chika Sakai, Tomohiko Tanigawa-Sugihara, Kayo Hayashida, Sumito Nishiuchi, Tatsuya Shiozaki, Tadahiko Tasaki, Osamu Kawamura, Takashi Hiraide, Atsushi Shimazu, Takeshi BMC Emerg Med Research Article BACKGROUND: Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergency medical service (EMS) and diagnosis of stroke among impaired consciousness patients. METHODS: We included all patients aged 18 years or older who were treated and transported by EMS, and had impaired consciousness (Japan Coma Scale ≧ 1) in Osaka City (2.7 million), Japan from January 1, 1998 through December 31, 2007. Data were prospectively collected by EMS personnel using a study-specific case report form. Multiple logistic regressions assessed the relationship between initial SBP and stroke and its subtypes adjusted for possible confounding factors. RESULTS: During these 10 years, a total of 1,840,784 emergency patients who were treated and transported by EMS were documented during the study period in Osaka City. Out of 128,678 with impaired consciousness, 106,706 who had prehospital SBP measurements in the field were eligible for our analyses. The proportion of patients with severe impaired consciousness significantly increased from 14.5% in the <100 mmHg SBP group to 27.6% in the > =200 mmHg SBP group (P for trend <0.001). The occurrence of stroke significantly increased with increasing SBP (adjusted odd ratio [AOR] 1.34, 95% confidence interval [CI] 1.33 to 1.35), and the AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 5.26 (95% CI 4.93 to 5.60). The AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 9.76 in subarachnoid hemorrhage (SAH), 16.16 in intracranial hemorrhage (ICH), and 1.52 in ischemic stroke (IS), and the AOR of SAH and ICH was greater than that of IS. CONCLUSIONS: Elevated SBP among emergency patients with impaired consciousness in the field was associated with increased diagnosis of stroke. BioMed Central 2013-12-17 /pmc/articles/PMC3878578/ /pubmed/24341562 http://dx.doi.org/10.1186/1471-227X-13-24 Text en Copyright © 2013 Irisawa et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Irisawa, Taro
Iwami, Taku
Kitamura, Tetsuhisa
Nishiyama, Chika
Sakai, Tomohiko
Tanigawa-Sugihara, Kayo
Hayashida, Sumito
Nishiuchi, Tatsuya
Shiozaki, Tadahiko
Tasaki, Osamu
Kawamura, Takashi
Hiraide, Atsushi
Shimazu, Takeshi
An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
title An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
title_full An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
title_fullStr An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
title_full_unstemmed An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
title_short An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
title_sort association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878578/
https://www.ncbi.nlm.nih.gov/pubmed/24341562
http://dx.doi.org/10.1186/1471-227X-13-24
work_keys_str_mv AT irisawataro anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT iwamitaku anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT kitamuratetsuhisa anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT nishiyamachika anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT sakaitomohiko anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT tanigawasugiharakayo anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT hayashidasumito anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT nishiuchitatsuya anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT shiozakitadahiko anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT tasakiosamu anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT kawamuratakashi anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT hiraideatsushi anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT shimazutakeshi anassociationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT irisawataro associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT iwamitaku associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT kitamuratetsuhisa associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT nishiyamachika associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT sakaitomohiko associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT tanigawasugiharakayo associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT hayashidasumito associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT nishiuchitatsuya associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT shiozakitadahiko associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT tasakiosamu associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT kawamuratakashi associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT hiraideatsushi associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings
AT shimazutakeshi associationbetweensystolicbloodpressureandstrokeamongpatientswithimpairedconsciousnessinoutofhospitalemergencysettings