title: Vomiting should be a prompt predictor of stroke outcome.
abstract: BACKGROUND
  To predict the outcome of stroke at an acute stage is important but still difficult. Vomiting is one of the commonest symptoms in stroke patients. The aim of this study is threefold: first, to examine the percentage of vomiting in each of the three major categories of strokes; second, to investigate the association between vomiting and other characteristics and third, to determine the correlation between vomiting and mortality.
  
  
  METHODS
  We investigated the existence or absence of vomiting in stroke patients in the Kyoto prefecture cohort. We compared the characteristics of patients with and without vomiting. We calculated the HR for death in both types of patients, adjusted for age, sex, blood pressure, arrhythmia, tobacco and alcohol use and paresis.
  
  
  RESULTS
  Of the 1968 confirmed stroke patients, 1349 (68.5%) had cerebral infarction (CI), 459 (23.3%) had cerebral haemorrhage (CH) and 152 (7.7%) had subarachnoid haemorrhage (SAH). Vomiting was seen in 14.5% of all stroke patients. When subdivided according to stroke type, vomiting was observed in 8.7% of CI, 23.7% of CH and 36.8% of SAH cases. HR for death and 95% CI were 5.06 and 3.26 to 7.84 (p<0.001) when all stroke patients were considered, 5.27 and 2.56 to 10.83 (p<0.001) in CI, 2.82 and 1.33 to 5.99 (p=0.007) in CH and 5.07 and 1.87 to 13.76 (p=0.001) in SAH.
  
  
  CONCLUSIONS
  Compared with patients without vomiting, the risk of death was significantly higher in patients with vomiting at the onset of stroke. Vomiting should be an early predictor of the outcome.
authors.affiliation: Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, Kyoto, Japan. neuron.k07@gmail.com
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shigematsu
authors.forename: Osamu
authors.initials: O
authors.lastname: Shimamura
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakano
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Sekimoto
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Shimizu
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nishizawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Makino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications; D002544:Cerebral Infarction / Q000150:complications; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D020521:Stroke / Q000150:complications / Q000401:mortality; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014839:Vomiting / Q000209:etiology* / Q000401:mortality