Social History Matters–The Impact of Illicit Drug Use on tPA Use and In-Hospital Mortality in Acute Ischemic Stroke
Matthew H. M. Marx
Department of Neurology, Tulane University Hospital, New Orleans, LA 70112, United States
Karen C. Albright
Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE),USA and Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC),USA and Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, England and Department of Neurology, School of Medicine, University of Alabama at Birmingham, United States
Amir Shaban
Department of Neurology, Tulane University Hospital, New Orleans, LA 70112, United States
Amelia K. Boehme
Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE),USA and Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC),USA
T. Mark Beasley
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, England
Sheryl Martin-Schild *
Department of Neurology, Tulane University Hospital, New Orleans, LA 70112, United States
*Author to whom correspondence should be addressed.
Abstract
Aims: The objective of this descriptive study was to compare time to medical evaluation, intravenous tissue plasminogen activator (IV tPA) use, and short-term outcomes in illicit drug users compared to non-users presenting with acute ischemic stroke (AIS).
Study Design: This is a retrospective study performed from our stroke registry using de-identified patient information.
Place and Duration of Study: Tulane Medical Center Primary Stroke Center (PSC). Consecutive AIS patients presenting to our PSC from July 2008 to December of 2010 were identified from our prospectively collected stroke registry.
Methodology: Patients were categorized as toxicology positive (TP) or toxicology negative (TN). We compared baseline characteristics, clinical presentation, tPA use, and short-term outcomes in TP and TN patients.
Results: Two hundred and sixty-three patients met inclusion criteria (median age 63, 35.4% female, 66.5% Black). Nearly 40% of toxicology screens were positive. Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; however, a higher proportion of TN patients were treated with IV tPA (32.1% vs. 21.2%). After adjustment for time from last seen normal to emergency department arrival (LSN-to-ED arrival), the odds of being treated with tPA for TP patients were similar to TN patients (OR 0.69, 95% CI 0.36-1.31, p=0.255). After adjustment for age, NIHSS, glucose, and tPA, the odds of in-hospital mortality in TP patients was 3 times that of TN patients (OR 3.17, 95% CI 1.07-9.43, p=0.038).
Conclusion: We found that the disparities observed in tPA use were attenuated after adjustment for time from LSN-to-ED arrival, suggesting an area for future intervention. Additionally, we found that TP patients may be at higher risk for in-hospital mortality. Further study on the role of substance abuse in time to ED arrival, tPA use, and outcome in AIS patients is warranted.
Keywords: Ischemic stroke, substance abuse, thrombolytic therapy, tissue plasminogen activator