120 Abstracts

is limited in that improved outcomes were shown in DWI(commonly available in specialist units), whereas CT tends tobe used in emergency rooms and population-based cohorts.This potentially changes outcomes based on treatment effectand referral bias.

[Matt Taecker, MD

Denver Health Medical Center, Denver, CO]

Comments: This study was limited by its retrospective de-sign. Based on the findings, the authors suggest that by utilizingnew sub-classifications of TIA defined as TP and TN, obtainableonly by magnetic resonance imaging (MRI), helpful prognosticinformation may be obtained. Unfortunately, as pointed out inthe article, MRI is not always readily available in the emergencydepartment, and more importantly, it is not clear that makingthis distinction leads to any meaningful change to treatment.

, RISK OF CONSTRICTIVE PERICARDITIS AFTERACUTE PERICARDITIS. Imazio M, Brucato A, Maestroni S,et al. Circulation 2011;124:1270–5.

This was a prospective cohort study out of Italy that aimed toevaluate the risk of developing constrictive pericarditis (CP) af-ter acute pericarditis (AP) with a risk assessment according tothe etiology. Five hundred cases of first-episode AP were clini-cally diagnosed by two of the following criteria: pericardialchest pain, pericardial friction rub, new diffuse ST-segmentelevation or PR depressions, or new or worsening pericardial ef-fusion. Cases were grouped based on the following etiologies:viral/idiopathic (n = 416), connective tissue disease/pericardialinjury syndromes (n = 36), neoplastic (n = 25), tuberculosis(n = 20), and purulent (n = 3); then prospectively followed fora median of 72 months to evaluate for progression to constric-tive pericarditis. The study found that CP was a rare complica-tion, with only 9 of the 500 cases of AP (1.8%) progressing toCP, with higher incidence in the non-viral/non-idiopathic group(n = 7) when compared to the viral/idiopathic group (n = 2).Incidences per 1000 person-years according to specific etiolo-gies were as follows: viral/idiopathic 0.76, pericardial injurysyndrome/connective tissue disease 4.40, neoplastic 6.33, tuber-culosis 31.65, and purulent 52.74. The researchers concludedthat the risk of developing CP after first-episode AP correlatedwith etiology, where bacterial causes were associated withthe highest risk. Researchers also found that non-viral/non-idiopathic causes of AP were associated with higher rates ofother adverse events during the follow-up period when com-pared to viral/idiopathic causes including: recurrent chestpain, recurrent pericarditis, and cardiac tamponade. Using bi-variate analysis, the researchers also explored other potentialrisk factors for developing CP and found that the followingfeatures occurred in higher frequency in the 9 cases of CPwhen compared to patients who did not develop CP:fever > 38 �C (66.7% vs. 14.5%; p < 0.001), incessant course(55.6% vs. 6.9%, p < 0.001), large pericardial effusion (66.7%vs. 8.6%, p < 0.001), cardiac tamponade (44.4% vs. 3.7%,p = 0.002), and non-steroidal anti-inflammatory drug failure(66.7% vs. 18.7%, p = 0.002).

[Lina Tran, MD

Denver Health Medical Center, Denver, CO]

Comment: This study demonstrates that constrictive pericar-ditis is a very rare complication of acute pericarditis and that italmost never occurs in cases of viral or idiopathic pericarditis.Unfortunately, due to the exceedingly small number of the otheretiologies and of the outcome of interest, little other usefulinformation can be taken from this otherwise well-designedprospective study.

, HEALTH INSURANCE STATUS, MEDICAL DEBT,AND THEIR IMPACT ON ACCESS TO CARE INARIZONA. Herman PM, Rissi JJ, Walsh ME. Am J PublicHealth 2011;101:1437–43.

This study used data from the 2008 Arizona Health Survey tocreate logistic regression models examining how health insur-ance status affected medical debt and access to care among2368 Arizona residents aged 18–64 years. Medical debt was de-fined as individuals who were having problems paying or werecurrently paying medical bills. Access to care was defined bydelayed or missed medical care or medications due to cost orlack of insurance. The authors found that an individual’s currentinsurance status was not an independent predictor of their med-ical debt. Importantly, however, individuals who had insuranceat the time of the survey but were uninsured at some time duringthe preceding year (inconsistent coverage) had the highest mea-sures of medical debt. These individuals had an adjusted oddsratio (AOR) of 2.48 for problems paying medical bills whencompared to thosewith consistent coverage. A second importantfinding emphasized by the investigators was that medical debt isa better predictor of problems accessing care than is insurancestatus. In predicting delayed medical care, insurance statushad an AOR = 0.32, compared to an AOR = 4.96 for problemspaying medical bills and an AOR = 3.04 for those currentlypaying off medical bills. Problems paying medical bills(AOR = 6.16) and currently paying medical bills (AOR = 3.68)predicted delayed medications.

[Mike MillerDenver Health Medical Center, Denver, CO]

Comments: When compared to the rest of the country, Ari-zonans report fewer problems with medical debt and inadequateaccess to care, making it unclear whether the findings of thisstudy are applicable to the country as a whole. However, thisstudy highlights the inadequacy of health insurance in protect-ing individuals from medical debt, the importance of consistentcoverage, and the power of medical debt as well as lack of insur-ance in predicting poor access to care. All of these factors willneed to be considered as the debate over health care and healthinsurance in the United States continues.

, PATIENTS WITH TRAUMATIC BRAIN INJURY.POPULATION-BASED STUDY SUGGESTS INCREASEDRISK OF STROKE. Chen YH, Kang JH, Lin, HC. Stroke2011;42:2733–9.

Traumatic brain injury is devastating, incurring significantmorbidity and mortality with sequelae of possible disease thatmay result from the injury: epilepsy, cognitive decline, psychi-atric disorders, etc. Researchers in this study investigated therisk for stroke after traumatic brain injury (TBI), hypothesizing