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Health Care Encounters Prior to Hospitalization for Cerebral Venous Thrombosis Patients

Published online by Cambridge University Press:  12 April 2024

Zeina Waheed Open the ORCID record for Zeina Waheed [Opens in a new window] ,
Thalia S. Field Open the ORCID record for Thalia S. Field [Opens in a new window]  and
Lily W. Zhou Open the ORCID record for Lily W. Zhou [Opens in a new window]
Zeina Waheed
Affiliation:
School of Public Health, University of British Columbia, Vancouver, BC, Canada
Thalia S. Field
Affiliation:
Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, BC, Canada
Lily W. Zhou*
Affiliation:
Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, BC, Canada
*
Corresponding author: Lily W. Zhou; Email: Lily.Zhou@vch.ca
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Abstract:

Background:

Unlike other causes of stroke, symptoms in cerebral venous thrombosis (CVT) can be nonspecific at onset with gradual worsening over time. To explore potential opportunities for earlier diagnosis, we analyzed healthcare interactions in the week prior to hospitalization for patients admitted with incident CVT in British Columbia (BC).

Methods:

We constructed a population-based cohort (2000–2017) using linked patient-level administrative data to identify patients aged ≥18 diagnosed with CVT in BC. We used descriptive analysis to describe the frequency and types of healthcare encounters within the 7 and 3 days prior to hospitalization. Multivariable logistic regression modeling was performed to examine risk factors associated with prior encounters.

Results:

The cohort included 554 patients (mean age 50.9 years, 55.4% female). Within the 7 days prior to CVT hospitalization, 57.9% of patients had ≥1 outpatient encounter and 5.6% had ≥1 inpatient encounter. In the 3 days prior to hospitalization, 46.8% of patients had ≥1 outpatient encounter and 2.0% had ≥1 inpatient encounter. Women more frequently had outpatient interactions within 7 days (64.8% women vs. 35.2% men, p < 0.001) and 3 days (51.8% vs. 48.2%, p = 0.01) before admission. Common provider specialties for outpatient encounters were general practice (58.0%), emergency (8.3%) and neurology (5.7%). Females had higher odds (OR = 1.79) of having ≥1 outpatient encounter after adjusting for confounding.

Conclusions:

Within our Canadian cohort, over half of patients had a healthcare encounter within 7 days before their hospitalization with incident CVT. Women more commonly had an outpatient encounter preceding hospital admission.

Résumé :

RÉSUMÉ :

Rencontres de patients atteints de thrombose veineuse cérébrale avec des professionnels de la santé avant leur hospitalisation.

Contexte :

Contrairement à d’autres causes d’AVC, les symptômes de la thrombose veineuse cérébrale (TVC) peuvent être non spécifiques au début et s’aggraver progressivement au fil du temps. Afin d’explorer les possibilités d’établir un diagnostic plus précoce, nous avons analysé les interactions avec des professionnels de la santé au cours de la semaine précédant l’hospitalisation de patients de Colombie-Britannique atteints d’une TVC.

Méthodes :

Pour les années 2000 à 2017, nous avons ainsi élaboré une cohorte basée sur la population en utilisant des données administratives liées aux patients pour identifier ceux âgés de ≥18 ans chez qui on avait diagnostiqué une TVC. Nous avons aussi utilisé une analyse descriptive pour décrire la fréquence et les types de rencontres avec des professionnels de la santé dans les 7 et 3 jours précédant l’hospitalisation. On a par ailleurs recouru à un modèle de régression logistique multivariable pour examiner les facteurs de risque associés aux rencontres antérieures.

Résultats :

Notre cohorte comprenait 554 patients (âge moyen : 50,9 ans ; 55,4 % de femmes). Dans les 7 jours précédant une hospitalisation en raison d’une TVC, 57,9 % des patients avaient eu ≥1 consultation externe et 5,6 % d’entre eux avaient eu ≥1 consultation interne. Dans les 3 jours précédant une hospitalisation, 46,8 % des patients avaient eu ≥1 consultation externe et 2,0 % d’entre eux avaient eu ≥1 consultation interne. Notons que ce sont les femmes qui ont le plus souvent bénéficié de consultations externes dans les 7 jours (64,8 % des femmes contre 35,2 % des hommes, p < 0 ,001) et dans les 3 jours (51,8 % contre 48,2 %, p = 0,01) précédant une hospitalisation. Les spécialités les plus courantes lors de consultations externes étaient la médecine générale (58 %), les urgences (8,3 %) et la neurologie (5,7 %). Enfin, les femmes ont donné à voir une probabilité plus élevée (RC = 1,79) d’avoir ≥1 consultation externe après ajustement sur les facteurs de confusion.

Conclusions :

Dans notre cohorte canadienne, plus de la moitié des patients ont obtenu une consultation médicale dans les 7 jours précédant leur hospitalisation pour une TVC. À noter que ce sont les femmes qui ont le plus souvent obtenu une consultation externe avant leur admission à l’hôpital.

Keywords

Cerebral venous thrombosisclinical epidemiologystroke
Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 7
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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