Abstract
AimsThe 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 DesignThis is a retrospective study performed from our stroke registry using deidentified patient information.Place and Duration of StudyTulane 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.MethodologyPatients 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.ResultsTwo 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).ConclusionWe 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.
Highlights
The 2011 National Survey on Drug Use and Health found that 6.3% of US adults, age 26 or older currently use illicit drugs [1]
Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; a higher proportion of toxicology negative (TN) patients were treated with intravenous tissue plasminogen activator (IV tissue plasminogen activator (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 toxicology positive (TP) patients were similar to TN patients
Summary
The 2011 National Survey on Drug Use and Health found that 6.3% of US adults, age 26 or older currently use illicit drugs [1]. National survey data suggest that rates of illicit drug use among adults ages 50 to 59 have been increasing since 2002 [1]. This increase has been attributed to the aging the baby boom cohort in which increased drug use during their youth may be being continued into older age [1]. No study has investigated intravenous (IV) recombinant tissue plasminogen activator (tPA) use in illicit drug users compared to non-users The objective of this descriptive study was to compare time to medical evaluation, tPA use, and short-term outcomes in illicit drug users compared to non-users presenting with AIS
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