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Vomiting should be a prompt predictor of stroke outcome
  1. Kazuo Shigematsu1,
  2. Osamu Shimamura2,
  3. Hiromi Nakano3,
  4. Yoshiyuki Watanabe2,
  5. Tatsuyuki Sekimoto4,
  6. Kouichiro Shimizu5,
  7. Akihiko Nishizawa6,
  8. Masahiro Makino2
  1. 1Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, Kyoto, Japan
  2. 2Department of Neurology and Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
  3. 3Department of Neurosurgery, Kyoto Kidugawa Hospital, Kyoto, Japan
  4. 4Department of Neurosurgery, Kyoto Prefectural Yosanoumi Hospital, Kyoto, Japan
  5. 5Department of Neurosurgery, Kyoto Fushimi Shimizu Hospital, Kyoto, Japan
  6. 6Department of Internal Medicine, Nishizawa Hospital, Kyoto, Japan
  1. Correspondence to Dr Kazuo Shigematsu, Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, 11 Nakaashihara, Jouyou-shi, Kyoto 610-0113, Japan; neuron.k07{at}gmail.com

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.

  • stroke
  • prehospital care
  • emergency department

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