0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Improving the Assessment of the Relationship Between Body Mass Index and Hospital Discharge After Ischemic Stroke

Cody Hamilton, PhD; Giovanni Filardo, PhD
Arch Neurol. 2007;64(10):1545-1546. doi:10.1001/archneur.64.10.1545-c.
Text Size: A A A
Published online

Extract

Razinia et al1 report that “[e]levated BMI [body mass index] is associated with a lower likelihood of being discharged home and a trend toward extended hospital stay.” However, this study suffers from several methodological drawbacks. Patients are divided into 4 prespecified groups based on the US Preventive Services Task Force, and statistical analyses are based on this categorization. The categorization of continuous exposures like BMI (calculated as weight in kilograms divided by height in meters squared) can lead to a biased estimation of the exposure-outcome relationship.2 Filardo et al3 have shown that using categorization when describing the relationship between BMI and postsurgical outcomes can misrepresent this relationship completely. Moreover, low patient counts for specific BMI categories can affect the statistical power of the analysis. For example, the adjusted comparison of discharge outcome between class I obesity and normal (which compares 61 patients with 208 patients) is significant at the .05 level (odds ratio, 0.46; 95% confidence interval, 0.22-0.96) while the smaller odds ratio describing the comparison between class II obesity and normal (which compares only 19 patients with 208 patients) is not (odds ratio, 0.42; 95% confidence interval, 0.13-1.37). Also, all subjects with BMIs of less than 25 are contained in the normal group, including any subjects with cachexia. Because patients with cachexia may suffer worse outcomes than patients with less extreme BMIs,4 the cutoff of 25 may combine patients with very different risk profiles. Smoothing techniques can avoid these inherent drawbacks of categorization.2,3 Finally, the suggestion that “higher BMI at the time of hospital admission for ischemic stroke is associated with a lower likelihood of being discharged directly home and longer stay in the hospital stroke service” contrasts with the fact that the overweight group has the best estimated risk (adjusted) for all 3 discharge outcomes.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

37 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();