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Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension.

TitleRisk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension.
Publication TypeJournal Article
Year of Publication2016
AuthorsNavi BB, Parikh NS, Lerario MP, Merkler AE, Lappin RI, Fahimi J, Iadecola C, Kamel H
JournalJ Stroke Cerebrovasc Dis
Volume25
Issue7
Pagination1683-1687
Date Published2016 Jul
ISSN1532-8511
KeywordsAdministrative Claims, Healthcare, Adult, Aged, Cross-Over Studies, Databases, Factual, Emergency Service, Hospital, Female, Humans, Hypertension, Intracranial Hemorrhage, Hypertensive, Male, Middle Aged, Odds Ratio, Patient Discharge, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, United States
Abstract

BACKGROUND: Recent literature suggests that acute rises in blood pressure may precede intracerebral hemorrhage. We therefore hypothesized that patients discharged from the emergency department with hypertension face an increased risk of intracerebral hemorrhage in subsequent weeks.

METHODS: Using administrative claims data from California, New York, and Florida, we identified all patients discharged from the emergency department from 2005 to 2011 with a primary diagnosis of hypertension (ICD-9-CM codes 401-405). We excluded patients if they were hospitalized from the emergency department or had prior histories of cerebrovascular disease at the index visit with hypertension. We used the Mantel-Haenszel estimator for matched data to compare each patient's odds of intracerebral hemorrhage during days 8-38 after emergency department discharge to the same patient's odds during days 373-403 after discharge. This cohort-crossover design with a 1-week washout period enabled individual patients to serve as their own controls, thereby minimizing confounding bias.

RESULTS: Among the 552,569 patients discharged from the emergency department with a primary diagnosis of hypertension, 93 (.017%) were diagnosed with intracerebral hemorrhage during days 8-38 after discharge compared to 70 (.013%) during days 373-403 (odds ratio 1.33, 95% confidence interval .96-1.84). The odds of intracerebral hemorrhage were increased in certain subgroups of patients (≥60 years of age and those with secondary discharge diagnoses besides hypertension), but absolute risks were low in all subgroups.

CONCLUSIONS: Patients with emergency department discharges for hypertension do not face a substantially increased short-term risk of intracerebral hemorrhage after discharge.

DOI10.1016/j.jstrokecerebrovasdis.2016.03.046
Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID27068776
PubMed Central IDPMC4912410
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
R37 NS089323 / NS / NINDS NIH HHS / United States

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