Neuroepidemiology
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Comparative Study
Neurological emergencies in India--lessons learnt and strategies to improve outcomes.
Neurological emergencies account for between 2.6 and 14% of medical emergencies, a number that can be salvaged, if addressed in time. This study aimed to answer the questions of demand, type and outcome of neurological emergencies by conducting a retrospective analysis of neurological emergencies serviced by 108, the first professional emergency service in India. ⋯ Emergency medical systems should implement a prehospital stroke protocol including the use of vital sign monitoring, point-of-care clinical diagnostics and advance forewarning systems. Geriatric clinics attending to the elderly age group, especially located in rural areas, with better identification of stroke and coma as medical emergencies, either through neuroimaging or clinical diagnostic facilities, will definitely improve outcomes. As seizures form a large chunk of neurological emergencies, genetic testing and counseling to detect hereditary causes could identify and keep most victims on regulated treatment in order to reduce adverse outcomes.
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Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001-2006) trends in stroke hospitalizations and hospital case-fatality for black, Hispanic, and white adults aged 25-49 years in Florida. ⋯ Our study found a strong and persistent black-white disparity in stroke hospitalization rates for young adults. In contrast, rates were similar for Hispanics and whites. Multivariate adjustment explained the 15% excess case-fatality for blacks; the short-term mortality advantage among Hispanics was strengthened after adjustment.