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In the News

From the June ACP Hospitalist, copyright © 2010 by the American College of Physicians

Web-based tool may help predict risk of short-term stroke recurrence

A Web-based prediction tool combining clinical and imaging information may be effective in predicting short-term risk of recurrent stroke, according to a study.

Researchers analyzed data on more than 1,400 consecutive ischemic stroke patients and calculated the 90-day risk of recurrent stroke. Predictors of recurrence included etiologic stroke subtype at admission, history of transient ischemic attack or stroke, and topography, age and distribution of brain infarcts. The recurrence risk estimator at 90 days (RRE-90) demonstrated good discrimination (area under the curve=0.80) in predicting 14- and 90-day risk of recurrence. The results appeared in the Jan. 12 Neurology.

The findings suggest that combining clinical variables with imaging information has better predictive value than clinical information alone or scores based on long-term risks, such as hypertension, diabetes and smoking, the authors said. The potential effectiveness of the RRE-90 is particularly significant considering that about half of 90-day recurrent strokes occur in the first two weeks.

Although the RRE-90 is easy to apply, several issues must be considered before incorporating the tool into clinical practice, said an accompanying editorial. For example, no follow-up information was available for almost half of the patients and the actual number of recurrent strokes was relatively small. In addition, the effect of early preventive treatment is unclear. For example, atrial fibrillation had no impact on recurrence using the RRE-90, suggesting that these patients may have been treated with early anticoagulation.

Independent, prospective validation is needed before the tool can be recommended for broader use, the editorial added. However, once validated, the Web-based tool can be easily and quickly expanded to many clinical settings, it said.

AHA updates recommendations on cardiovascular IED infections

The American Heart Association has updated its 2003 recommendations on caring for patients with suspected or established cardiovascular implantable electronic device (CIED) infections.

Many research advances have been made since 2003, which led the AHA to issue its updated scientific statement on the diagnosis and management of these infections. The update, published Jan. 26 by Circulation, includes the following recommendations:

• All patients should have at least two sets of blood cultures drawn at the initial evaluation before prompt initiation of antimicrobial therapy for CIED infection.
• Duration of antimicrobial therapy should be 10 to 14 days after CIED removal for pocket-site infection and at least 14 days after CIED removal for bloodstream infection.
• All patients with definite CIED infection, as evidenced by valvular and/or lead endocarditis or sepsis, should have their devices and leads removed completely.
• Long-term suppressive therapy should be considered for patients who have CIED infection and are not candidates for complete device removal.
• Prophylaxis with an antibiotic that has in vitro activity against staphylococci should be administered. If cefazolin is selected, then it should be administered intravenously within 1 hour before incision; if vancomycin is given, then it should be administered intravenously within 2 hours before incision.

In the News is a product of ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you're not already receiving ACP HospitalistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or directly at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an e-mail.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated