Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.
Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome.
Ferro
José M
JM
Centro de Estudos Egas Moniz, Department of Neurology at Hospital Santa Maria, Lisboa, Portugal. jmferro@fm.ul.pt
Lopes
M G
MG
Rosas
M J
MJ
Fontes
J
J
D000925:Anticoagulants / Q000627:therapeutic use; D004388:Dura Mater / Q000098:blood supply; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011174:Portugal / Q000453:epidemiology; D012720:Severity of Illness Index; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors
D000925:Anticoagulants