Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Sep 2004
Determining the appropriateness of selected surgical and medical management options in recurrent stroke prevention: a guideline for primary care physicians from the National Stroke Association work group on recurrent stroke prevention.
Despite a decade of successful clinical trials for stroke prevention, substantial gaps exist in the application and implementation of this information in community practice. The frequency of guideline use is low, and there remains controversy regarding the standard of practice. Patients with stroke may have multiple risk factors and concomitant stroke mechanisms, factors that are not addressed in stroke clinical trials and guideline statements. ⋯ Appropriateness was less where bleeding or surgical risk was excessive. Using consensus evidence from clinical trials, we have developed recurrent stroke prevention guidelines for routine and more complex patient scenarios according to appropriateness methodology. Broad application of these guidelines in primary practice promises to reduce the burden of recurrent stroke.
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We sought to identify predictors of death or discharge to home for patients with nontraumatic subdural hematoma (NT-SDH). ⋯ In this study, GCS score was the major predictor of outcome. Patients with NT-SDH who were male or with good GCS score were less likely to die and more likely to be discharged home. Unlike patients with intracerebral hemorrhage (ICH),lesion size did not predict outcome for patients with NT-SDH. Extent of involvement (on the right side) was a predictor of death.