Georgeta D. Vaidean

Stroke in crack–cocaine abusers is increasingly recognized. We aimed to identify significant differences in stroke risk factors, characteristics, and outcomes between hospitalized stroke patients with and without crack–cocaine abuse. This was a retrospective study that compared stroke patients with crack–cocaine abuse (cases) to stroke patients without crack–cocaine (controls). We identified 93 crack–cocaine cases and 93 controls admitted between January 2004 and May 2006 to one teaching hospital. There were significant differences between crack–cocaine cases and controls in age (48.7 years vs. 55 years) (P = 0.0001), male gender (65.6% vs. 40.9%) (odds ratios, OR = 1.64, 95% CI 1.22–2.21), arterial hypertension (61.1% vs. 83.9%) (OR = 0.30, 95% CI 0.15–0.60), hypercholesterolemia (18.7% vs. 68.5%) (OR = 0.10, 95% CI 0.05–0.21), diabetes (20.9% vs. 41.9%) (OR = 0.36, 95% CI 0.19–0.70), cigarette smoking (70.6% vs. 29%) (OR = 5.86, 95% CI 3.07–11.20), ischemic stroke (61.3% vs. 79.6%) (OR = 0.40, 95% CI 0.21–0.78), and intracerebral hemorrhage (33.3% vs. 17.2%) (OR = 3.03, 95% CI 1.53–6.00). Also, there were significant differences in National Institutes of Health Stroke Scale scores (3.3 vs. 7) (P < 0.0001), and MRS scores (1.8 vs. 2.5) (P = 0.0022) at hospital discharge. Using univariable and multivariable logistic regression, we found that crack–cocaine abusers had 2.28 higher odds of having a favorable functional outcome (MRS score ≤ 2) at hospital discharge, after adjusting for stroke risk factors and characteristics. Our study suggests that crack–cocaine abusers with stroke had fewer traditional risk factors, and more favorable functional outcome as compared to non-crack–cocaine abusers.

Background: Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. Methods: We identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were ascertained using weekly telephone surveillance for 4 weeks post-discharge. Patients were followed until death, loss to follow up or end of study (four weeks). Time spent rehospitalized or institutionalized was censored in rate calculations. Results: Of 95 hospitalized patients who fell during recruitment, 65 (68%) met inclusion criteria and agreed to participate. These subjects contributed 1498 person-days to the study (mean duration of follow-up = 23 days). Seventy-five percent were African-American and 43% were women. Sixteen patients (25%) had multiple falls during hospitalization and 23 patients (35%) suffered a fall-related injury during hospitalization. Nineteen patients (29%) experienced 38 falls at their homes, yielding a fall rate of 25.4/1,000 person-days (95% CI: 17.3-33.4). Twenty-three patients (35%) were readmitted and 3(5%) died. One patient experienced a hip fracture. In exploratory univariate analysis, persons who were likely to fall at home were those who sustained multiple falls in the hospital (p = 0.008). Conclusion: Patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge. Interventions to reduce falls would be appropriate to test in this high-risk population.