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Background: Hispanics are one of the largest and fastest-growing population in the United States. Having been reported as one of the high-risk ethnicities to develop Alzheimer's Disease (AD) makes elder Hispanics one of the significant groups of AD in the country, indicating a need to study the disparities in Hispanics vs. non-Hispanics patients. We aimed to determine the prevalence, morbidity, and mortality outcomes of AD in Hispanics., Methods: We surveyed Healthcare Cost and Utilization Project (HCUP) from 2005 to 2015 to identify patients older than 50 years who were admitted for any reason and had AD diagnosis. Prevalence, demographics, age brackets, in-hospital deaths, disease severity, and hospital length of stay (LOS) were compared between the Hispanics and Non-Hispanics., Results: Among 14,135,560 Hispanic discharges, 2.76% had AD, compared with 207,515,260 discharges in Non-Hispanic with 2.61% AD, p < 0.001. Hispanics had significantly more AD in all age brackets, especially over 90 years of age, p < 0.001. A significantly higher prevalence of AD in both Hispanic Females (3.27% vs. 3.10%) and Males (2.17% vs. 2.04%) was noticed, p < 0.001. In northeast and south regions of the country and urban hospitals, AD was more among Hispanics (p < 0.001). Hispanic patients were younger (81.8 ± 7.77 vs. 82.6 ± 7.50, p < 0.001), had longer LOS (6.41 ± 7.72 vs. 6.08 ± 7.05, p < 0.001), had higher hospital charges ($45,989 vs. $37,688, p < 0.001). Hispanic AD patients had higher disease severity and mortality risk (p < 0.001). However, the inpatient mortality was not different between the Hispanic and non-Hispanics. Multivariate analysis showed that Hispanics had the highest AD prevalence in the inpatient setting (OR, 1.38; 95% CI, 1.37-1.39, p < 0.001)., Conclusion: The prevalence of AD was significantly higher in inpatient Hispanics than non-Hispanics. Hispanic AD patients had a younger age compared with non-Hispanic AD. Disease severity and mortality risks were higher in Hispanics with AD than non-Hispanics with AD. However, no difference was seen in mortality rate during admission in Hispanics vs. non-Hispanics., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: This study investigates the effect of aneurysm circulation on mortality and patient outcomes after aneurysmal subarachnoid hemorrhage (SAH) within the United States., Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS), a part of the Healthcare Cost and Utilization Project (HCUP), with ICD-10 codes for non-traumatic SAH between 2015-2016. Aneurysms were stratified as either anterior or posterior circulation. Multivariate logistic regression was used to find the impact of selected variables on the odds of mortality., Results: The NIS reported 1,892 cases of non-traumatic SAH within the study period that were predominantly anterior circulation (82.6%), female (68.6%), white (57.7%), with mean age of 59.07 years, and in-hospital mortality of 21.4%. Anterior circulation aneurysms were associated with lower severity of initial illness (p = 0.014) but higher likelihood of vasospasm (p = 0.0006) than those of the posterior circulation. In a multivariate logistic regression analysis, mortality was associated with posterior circulation aneurysms (OR: 1.42; CI 95% 1.005-20.10, p = 0.047), increasing age (OR: 1.035; 95% CI 1.022-1.049; p < 0.0001), and shorter hospital stays (OR: 0.7838; 95% CI 0.758-0.811; p < 0.0001). Smoking history (OR: 0.825; 95% CI 0.573-1.187, p > 0.05) and vasospasm (OR: 1.005; 95% CI 0.648-1.558; p > 0.05) were not significantly associated with higher odds of mortality., Conclusions: Mortality following aneurysmal SAH is associated with posterior circulation aneurysms, and increasing age, but not smoking history or vasospasm. These findings may be useful for prognostication and counseling patients and families., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The management of patients suffering traumatic brain injury (TBI) in the context of multiple significant trauma represents one of the most challenging scenarios in trauma critical care. The identification of risk factors, utilizing large national databases, may help in developing medical strategies and health care policies aimed at improving outcomes in these patients. In this study, our aim was to assess in-hospital mortality following craniotomy for multiple significant trauma in the United States., Patient and Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS) on subjects having "Craniotomy with Multiple Significant Trauma" between 2008-2016. Multivariate logistic regression was used to find the impact of selected variables on the odds of mortality., Results: There were 26,650 discharges within the study period that were predominantly male (73.2%), white (65.1%), with a mean age of 39.7 ± 22.3, and in-hospital mortality of 35.4%. During the study period, the mortality of this population increased from 34.8% to 38.3% (p = 0.18). In a multivariate logistic regression analysis, the following conditions were associated with higher mortality: being on pressors (OR: 8.41; CI 95% 5.55-12.75, p = 0), having Status Epilepticus (OR: 3.33; CI 95% 1.26-8.81, p = 0.015), self-pay (OR: 4.81; CI 95% 1.49-2.59, p = 0), privately insured (OR: 1.97; CI 95% 1.49-2.59, p = 0) and discharge from urban teaching hospitals (OR = 1.4; CI 95% 1.16-1.68, p = 0)., Conclusion: Patients who underwent craniotomy with multiple significant trauma had high mortality, at a rate of about one in three; mortality has been increasing during recent years. Those who required vasopressors and those who developed Status Epilepticus had a significant association with higher death. These associations may be due to the complexity of injuries in this population. Patients with these conditions should seek further attention by the clinicians. Further studies are warranted to characterize these differences., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: Over the last two decades, various studies have evaluated the impact of weekend admission to the hospital on inpatient mortality. Our study sought to identify whether or not the "weekend effect" was true for patients with Intracranial Hemorrhage (ICH) admitted to United States hospitals and whether or not the introduction of comprehensive stroke centers (CSCs) made an impact on the "weekend effect" for ICH., Patients and Methods: Searched the Nationwide Inpatient Sample for the ICH discharges between 2006 and 2014. Multivariate regression analysis was performed to evaluate the factors that impacted in-hospital mortality. Additional subgroup analysis was performed based on two time periods, before CSCs (2006-2009) and afterward (2010-2014)., Results: 146,587 discharges with ICH were reported by the NIS with 37,471 (25.6%) weekend admissions. The weekday admission cohort was 50.6% male with a mean age of 67.1 years. There was a total of 35,362 deaths among ICH admissions. The in-hospital mortality rate was significantly higher for weekend admissions compared to that of weekday admissions (25.2% vs. 23.8%, p < 0.001). Multivariate analysis of mortality for the 2006-2009 subgroup demonstrated a statistically significant higher odds of death with weekend admission (OR = 1.15, 95% CI [1.10, 1.20], p = 0) but not for the 2010-2014 subgroup (OR = 1.03, 95% CI [0.99, 1.07], p = 0.09)., Conclusion: Our study showed that in-hospital mortality was found to be increased for patients with ICH admitted on a weekend; however, this association was lost after the initiation of CSCs. Further prospective studies are warranted to gain a better understanding regarding this association., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: Multiple studies have shown worse outcomes in patients admitted for medical and surgical conditions on the weekend. However, past literature analyzing this "weekend effect" on subarachnoid hemorrhage (SAH) found no significant increase in mortality. This study utilizes more recent data to re-evaluate the association between weekend admission and mortality of patients hospitalized for SAH., Methods: This retrospective cohort study queried the SAH patients in the Nationwide Inpatient Sample (NIS) database who were discharged from 2006 through 2014 during the weekend., Results: Of the 54,703 admissions for SAH identified during the study period, 14,821 (27.1%) occurred over the weekend. Patients admitted over the weekend had a mean age of 59.2 years and were most likely to be female (59.6%), to be white (62.9%), located in the south region of the USA (40.1%), and be admitted to a teaching hospital (74.4%). When compared directly to weekday admissions, patients admitted over the weekend had higher odds of in-hospital mortality (odds ratio 1.07; confidence interval 95%, 1.02-1.12). There was no significant difference shown in the rate patients get surgical clipping versus endovascular coiling (p = 0.28) or the amount of time between admission to procedure for clipping (p = 0.473) or coiling (p = 0.255) on the weekend versus a weekday., Conclusion: Based on our findings, the likelihood of the in-hospital mortality was higher for patients admitted over the weekend. However, the characteristics of the study, primarily observational, prevent us arriving at an accurate conclusion about why this occurs; hence, we believe it is an important starting point to consider for future research.

Objective: The association between obesity and nontraumatic subarachnoid hemorrhage (SAH) patient outcome is unclear. The aim of this study was to determine the impact of morbid obesity (body mass index ≥40 kg/m 2 ) on nontraumatic SAH outcomes., Methods: Using the Nationwide Inpatient Sample, we identified hospitalized, nontraumatic SAH patients who received their diagnoses from 2008 to 2013 and tested the effect of obesity on their mortality and clinical outcomes. Odds ratios were estimated with a mixed effects linear logistic model with adjustment for hospital clustering. All statistical testing was 2-sided, with a significance level of 5%., Results: Out of 224,561 discharged patients with a diagnosis of nontraumatic SAH, 4714 (2.10%) were defined as morbidly obese. Patients with morbid obesity were younger (54.3 ± 0.44 vs. 59.5 ± 0.08 years; P < 0.001) and had longer length of stay (LOS) (13 ± 0.46 vs. 11.5 ± 0.06 days; P = 0.002). Morbid obesity was associated with significantly higher hospital costs (P < 0.001) and charges (P < 0.001). The risk of acute respiratory failure was higher in morbidly obese patients (odds ratio [OR] 1.49, 95% confidence interval [CI]: 1.3-1.71, P < 0.001). In a multivariate analysis of hospital mortality, obesity had a negative impact on mortality (OR 0.83, 95% CI: 0.74-0.92, P < 0.001). Overall, in-hospital mortality was associated with age, morbid obesity, LOS, clipping and coiling, and acute respiratory failure but not the symptomatic vasospasm., Conclusions: Morbid obesity is associated with increased LOS, hospital costs and charges and with acute respiratory failure. However, it is also associated with a decrease in hospital mortality., (Published by Elsevier Inc.)

Background: Patients with traumatic brain injuries (TBIs) have an increased risk of developing a deep vein thrombosis (DVT), but the risk of hemorrhage expansion with intracranial monitoring devices remains unknown. We sought to determine the safety of chemical DVT prophylaxis in severe TBI patients with invasive intracranial pressure monitors., Methods: We retrospectively reviewed all patients with severe TBI admitted to the neurosurgical intensive care unit of a large tertiary care center over a three-year period., Results: 155 patients were included with an incidence of DVT of 12 %. The median length of time to a stable head CT was 2 days, and the median time to initiation of chemical DVT prophylaxis was 3.6 days. The odds of DVT increased with intraparenchymal hemorrhage [OR 7.21, 95 % CI (1.43-36.47), p = 0.0169], non-White ethnicity [OR 7.86, 95 % CI (1.23-50.35), p = 0.0295], female gender [OR 13.93, 95 % CI (2.47-78.73), p = 0.0029], smoking [OR 4.32, 95 % CI (1.07-17.51), p = 0.0405], no anticoagulation [OR 25.39, 95 % CI (4.26-151.48), p < 0.001], and an IVC filter [OR 15.82, 95 % CI (3.14-79.76), p < 0.001]. Twenty-eight (18 %) of these subjects experienced in-hospital mortality. The risk of in-hospital death was significantly increased among those who did not receive anticoagulation. This study found no association between DVT formation, hemorrhage expansion, or increased risk from invasive monitoring devices between various doses of unfractionated heparin (UH) and low-molecular-weight heparin (LMWH)., Conclusion: We conclude that DVT prophylaxis with either LMWH or UH is safe with intracranial pressure monitors in place.

Background: The impact of the 2003 residency duty hour reform on patient care remains a debated issue., Objective: Determine the association between duty hour limits and mortality in patients with nervous system pathology., Methods: Via a retrospective cohort study using the Nationwide Inpatient Sample from 2000-2010, the authors evaluated in-hospital mortality status in those with a primary discharge level diagnosis of disease or disorder of the nervous system. Odds ratios were calculated, and Bonferroni corrected P values and confidence intervals were determined to account for multiple comparisons relating in-hospital mortality with teaching status of the hospital by year., Results: The pre-reform (2000-2002) and peri-reform (2003) periods revealed no significant difference between teaching and nonteaching hospital mortality ( P  > .99). The post-reform period (2004-2010) was dominated by years of significantly higher mortality rates in teaching hospitals compared to nonteaching hospitals: 2004 ( P  < .001); 2006 ( P  = .043); 2007 ( P  = .042); and 2010 ( P  = .003). However, data for 2005 ( P  ≥ .99), 2008 ( P  = .80), and 2009 ( P  = .09) did not show a significant difference in mortality., Conclusions: Teaching and nonteaching hospital mortality was similar in patients with nervous system pathology prior to the duty hour reform. While nonteaching institutions demonstrated steadily declining mortality over the decade, teaching hospital mortality spiked in 2004 and declined at a more restricted rate. The timing of these changes could suggest a negative correlation of duty hour restrictions on outcomes of patients with nervous system pathology., Competing Interests: The authors declare they have no competing interests.

Objectives: Safety of intravenous thrombolysis (IVT) within 3–4.5 hours of stroke onset in patients ≥80 years is still disputable. We evaluated the association of symptom onset‐to‐treatment time (SOTT) with the symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in patients≥80 years. Materials and Methods: In a retrospective study, patients treated with IVT following stroke were registered. Outcomes were poor outcome (mRS>2), sICH/ECASS‐2, and in‐hospital mortality. We compared the patients≥80 years who received IVT within 3 hours with those receiving IVT within 3–4.5 hours. We further compared the patients who were <80 years with those ≥80 years and SOTT of 3–4.5 hours. Results: Of 834 patients, 265 aged over 80. In those above 80 and in multivariable analysis, the associations of SOTT with poor outcome (aOR: 1.401, CI: 0.503–3.903, p=0.519), sICH (aOR=2.50, CI=0.76–8.26, p= 0.132) and mortality (aOR=1.12, CI=0.39–3.25, p= 0.833) were not significant. 106 patients received IVT within 3–4.5 hours. In multivariable analysis, the associations of age (≥80 versus <80) with poor outcome (aOR=1.87, CI=0.65–5.37, p=0.246), sICH (aOR=0.65, CI=0.14–3.11, p=0.590), and mortality (aOR=0.87, 95% CI=0.16–4.57, p=0.867) were not significant in patients with SOTT of 3–4.5 hours. Conclusion: IVT within 3–4.5 hours in patients ≥80 years is not associated with increased sICH, poor outcome, and mortality compared to the early time window, and also compared to the younger patients in 3–4.5 hours window period. The decision of IVT administration in this age group should not be made solely on the basis of stroke onset timing. [ABSTRACT FROM AUTHOR]

Background No studies have assessed the incidence of craniocervical arterial dissections (CCADs) and its association to mortality in hospitalized patients with a primary diagnosis of atraumatic subarachnoid hemorrhage (SAH) requiring aneurysmal repair. We hypothesize that the incidence of CCADs in these patients has increased over time as well as its association to mortality. Methods We conducted a 9 year retrospective assessment of the incidence of CCADs in patients hospitalized with a primary diagnosis of an SAH requiring repair and the effect of CCAD on mortality. Using the Nationwide Inpatient Sample (NIS), we queried records from 2003 to 2011 for an ICD-9 (International Classification of Diseases-9) code corresponding to admissions for atraumatic SAH. Demographical data, incidence of CCADs, type of aneurysmal repair, length of hospital stay, and hospital mortality were recorded. Multivariate logistical regression models were fitted to assess for the impact of CCAD on inhospital mortality and morbidity. Results During the period 2003 - 2011, of the NIS reported 18 260 patients who required aneurysmal SAH repair, 9737 (53.32%) underwent endovascular coiling and 8523 (46.48%) had surgical clipping. There were 131 patients in the cohort with reported CCADs: 94 (71.75%) of these patients had received endovascular coiling repair and 37 (28.25%) had undergone surgical clipping repair. Patients who underwent endovascular coiling had a higher rate of CCADs in this cohort (OR 2.94; 95% CI 2.00 to 4.31, p<0.0001). The incidence of CCADs in this population increased by an average rate of 9.4% per year (OR 1.14; 95% CI 1.06 to 1.23, p<0.0006), from 0.49% in 2003 to 1.10% in 2011. The diagnosis of CCAD added 3 and 6 more days to median length of hospitalization stay for surgical clipping and endovascular coiling, respectively. The unadjusted rate of mortality was 8.4% in the CCADs subgroup, and the presence of CCAD was not a predictor of mortality in our multivariate regression model (OR 0.68; 95% CI 0.36 to 1.27, p=0.2244). Conclusions Our study indicates an annual increase in the incidence of CCADs in patients admitted with SAH who require aneurysmal repair. More than two-thirds of these patients that developed CCADs had undergone endovascular coiling repair. A diagnosis of CCAD increased the length of hospital stay but had no statistically significant association with mortality in this patient population. [ABSTRACT FROM AUTHOR]

Introduction of the International Classification of Diseases, Tenth Revision (ICD-10) in 2015 was aimed for a more detailed classification of mortality statistics of diseases, such as classifying the anatomical locations for intracerebral hemorrhage (ICH). We aimed to describe the demographics and in-hospital mortality of specified ICH locations based on ICD-10 classification. Patients with a principal diagnosis of spontaneous ICH in the United States, extracted from the Nationwide Inpatient Sample (NIS) from 2015 to 2018. Subgroups of ICH locations were analyzed individually for age, gender, ethnicity, in-hospital mortality, hospital length of stay (LOS), hospital cost, and EVD placement. During the study period, there were 408,285 ICH patients with a mean age of 66.28 (17.11) years, 52.09% male, mainly Intraventricular (21.87%) and cortical hemispheres (19.83%). Total ICH in-hospital mortality was 21.07%, while brainstem was associated with the highest in-hospital mortality (40.68%) followed by intraventricular (33.08%) and multiple localized locations (30.16%). The mean hospital length of stay was 9.56(14.10) days, and the mean hospital cost was $32,453.38(56,851.59). Intraventricular Hemorrhage had the highest hospital LOS 12.39(17.44) and the highest hospital cost $47,385.25(76,187.5). Our results characterized the demographics of ICH in the US with in-hospital mortality of one out of five patients. Detail breakdown of ICH locations can improve the mortality statistics and provide more information about the ICH locations with higher hospital expenses. • Intracerebral Hemorrhage in the US has in-hospital mortality of 21.07%, which is one out of every five patients. • Intraventricular hemorrhage and cortical hemorrhages are the most reported specified locations in the ICD-10 coding system. • The highest reported mortality was in the brain stem intracerebral hemorrhage, and the highest hospital expenses belong to intraventricular hemorrhages. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to identify the incidence of anesthetic errors per discharges in the United States within these errors, the incidence of death. A secondary aim was to identify any association between the mortality and patient comorbidities.Methods: A retrospective analysis of the hospitals in the United States using the Nationwide Inpatient Sample (NIS) database during 2007-2014 was performed. The study population consisted of patients who were recorded as inpatient discharges who experienced complications as a result of incorrect anesthetic administration resulting from either an overdose or inappropriate medication administration in the United States.Results: Between 2007 and 2014, a total of 17,116 anesthetic errors were reported. There was a substantial decrease in the total number of these errors over time, from 2483 in 2007 to 1391 in 2014 (44% decrease). There were 131 reported deaths in this cohort (0.77% mortality rate), with 61 mortalities in teaching hospitals (0.86% mortality rate) and 57 in nonteaching hospitals (0.73% mortality rate). During the study period, deaths decreased from 21 in 2007 (0.85% mortality rate) to 11 in 2014 (0.79% mortality rate), corresponding with a 7.1% decrease in the mortality rate. Comorbidities associated with a significant increase in mortality from anesthetic substances included fluid and electrolyte disorders (odds ratio 8.82, 95% confidence interval 5.24-14.83, P < 0.001) and coagulopathies (odds ratio 5.26, 95% confidence interval 2.53-10.93, P < 0.001).Conclusions: Our study showed that although the incidence of anesthetic errors is small, they do still exist in our hospitals. Certain comorbidities appear to predispose patients to increased risk. The subsets of patients who appear to be at the greatest risk include those with preexisting electrolyte and fluid disorders and coagulopathies. [ABSTRACT FROM AUTHOR]

B Learning Objectives: b Hypertensive encephalopathy is a lethal manifestation of hypertensive crises (BP >= 180mmHg systolic or >= 120mmHg diastolic), often characterized by severe headaches, convulsions, coma, and other life-threatening neurological symptoms. Z-tests were then calculated to examine discharge rates, outcomes, and gender differences in patients presenting with hypertensive encephalopathy during the study period. B Conclusions: b Rising incidence of hypertensive encephalopathy mirrors the increasing rates of hypertension and hypertensive crisis diagnoses in the United States over the past decade. [Extracted from the article]

• There is a significant increase in the number of seizure diagnosis at discharge in Medicare, Medicaid, and private in the United States between 1997-2014. • There was a decrease in the in-hospital mortality rate across all insurance payers. • Uninsured patients had the highest mortality rate after Medicare without risk justification. • Risk-stratified models confirmed Medicare was significantly associated with a less in-hospital mortality rate. In countries where health coverage is not universal, there is ample evidence of disparities in healthcare, often associated with insurance. People with seizures, similar to those living with any complicated chronic medical comorbidity, need further health-related attention to improve their quality-of-life outcomes. We conducted a retrospective cohort study of the National Inpatient Sample (NIS) component of the Healthcare Cost and Utilization Project (HCUP) national database between 1997–2014. The analysis focused on the mortality rate, and patients with a principal admission diagnosis of seizure at the time of discharge were identified. Primary Payer Status (PPS) included Medicare, Medicaid, private, and uninsured. Multivariate linear regression modeling was conducted to examine the contribution of the predictive variables to in-hospital mortality. Between 1997–2014, 4,594,213 seizure-related discharges was recorded. The overall mean patient age was 41.69 ± 0.98 years, and 58.1 % were female. The average age during this period decreased significantly in Medicare, increased substantially in uninsured, without significant change in Medicaid and private. Patients in Medicare had the highest length of stay (LOS) (4.49 ± 0.29 days), and uninsured (2.79 ± 0.15) had the least. Over time, there was a significant increase in the number of seizure discharges in Medicare, Medicaid, and private insurance. However, there was a significant decrease in in-hospital mortality in Medicare, Medicaid, and private, with the most prominent decline in Medicare. Risk-adjusted for age, gender, LOS, illness severity, and time, regression results showed Medicare has a significantly higher association with less in-hospital mortality compared with other insurances. Our study showed a significant increase in the number of seizure diagnoses at discharge in Medicare, Medicaid, and private in the United States between 1997–2014; however, there was a decrease in the in-hospital mortality rate across all insurance payers. Uninsured patients had the highest mortality rate after Medicare without risk justification. Risk-stratified models confirmed Medicare was significantly associated with a less in-hospital mortality rate. [ABSTRACT FROM AUTHOR]

B Learning Objectives: b Primary intracerebral hemorrhage (ICH) causes up to 15% of strokes, with about 50% mortality within 30 days. Coagulopathy was the strongest mortality risk factor for all ICH admissions among medical comorbidities in the study (OR 1.90). Comorbidities associated with decreased mortality for all ICH admissions included complicated diabetes mellitus (OR 0.76), obesity (OR 0.81), and hypertension (OR 0.83). [Extracted from the article]