Neurology

Avoid intensive glucose control in acute stroke

In this randomized trial of 180 patients with acute ischemic stroke, the use of intensive insulin control was associated with higher infarct growth, compared to usual subcutaneous insulin (regardless of admission glucose). There were no differences between the groups in functional outcome, death, or serious adverse events. Intensive blood sugar control can not currently be recommended in acute stroke patients (abstract)

Worse stroke outcomes on weekends

In this retrospective cohort from the National Health Service, the risk of mortality in stroke patients was significantly higher for patients admitted on weekends, compared to weekdays. Although this is from the NHS, the results are similar to previous studies from the US, and needs to serve as a call for action to reduce disparities in care by day of week (abstract)

Risk factors for death after syncope

In this large retrospective analysis of patients discharged from the ED with syncope, 30 day mortality was independently associated with older age (>60), CHF, seizures, diabetes, and dementia. Close follow up is advised when discharging patients with syncope and these risk factors (abstract)

Delirium outcomes in those with Alzheimers

In this large observational study of patients with Alzheimers, about half were admitted, and a quarter experienced delirium, within 18 months. Those who were admitted to the hospital and experienced delirium were 5 and 9 times more likely to die or be institutionalized, respectively, compared to those not hospitalized. Although speculative, early diagnosis and treatment of delirium may improve outcomes (death or institutionalization) in patients with Alzheimers (abstract)
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