Cerebrovascular disease is the most common cause of death in China, and the incidence of ischemic stroke (240 per 100,000 people) is higher than that of hemorrhagic stroke (82 per 100,000 people). More than 80 percent of strokes can be prevented by early control of risk factors. Therefore, identifying and managing high-risk groups is a top priority in preventing stroke. The CHA2DS2-VASc score is a key prediction tool for stratifying stroke risk in individuals with atrial fibrillation (AF) as follows: zero score is low risk; one is intermediate risk; and two is high risk. The present study was undertaken to evaluate the accuracy of the CHA2DS2-VASc scoring system for stratifying ischemic stroke risk in the non-AF population.

We searched PubMed, EMBASE, and the Cochrane Library in June 2018 for relevant diagnostic studies. Study selection, data extraction, and quality assessment (using the QUADAS-2 criteria) were performed independently by two authors. Methodological variation across the selected studies precluded meta-analysis, so the results were synthesized narratively.

Seven prospective studies involving 50,652 patients (6,760 with ischemic stroke) were included. The treatment threshold ranged from two to four across the studies. Three studies reported diagnostic accuracy at a threshold of two, with a sensitivity above 0.8 and a specificity ranging from 0.32 to 0.68. The diagnostic odds ratio was greater than two (seven studies). The two studies using a treatment threshold of four reported a sensitivity of 0.59 to 0.76 and a specificity of 0.43 to 0.69. One study used a threshold of three, with a sensitivity of 0.79 and a specificity of 0.39.

The CHA2DS2-VASc score may be used to predict ischemic stroke in the non-atrial fibrillation population. Treatment thresholds greater than two provide more optimal diagnostic accuracy, although the predictive performance of the CHA2DS2-VASc score may be better in patients with chronic obstructive pulmonary disease but not AF.

Rashkind balloon atrial septostomy is a common cardiac procedure aimed at improving systemic oxygenation in newborns with cyanotic congenital cardiac defects, such as transposition of the great arteries. Recent reports on the safety of this procedure were from limited series at single institutions. We analysed two complementary national databases to evaluate clinically relevant outcomes of this procedure.

We performed an analysis of transposition of the great artery patients nationwide using 15 years of the Nationwide In-patient Sample and three complementary years of the Kids’ Inpatient Database. Variables included gender, race, age, and co-existing diagnoses. Outcomes included mortality, length of stay, and hospital charges. Comparison between patients undergoing Rashkind procedure or not was performed using Pearson’s chi-square and Kruskal–Wallis tests. We identified 8681 patients with transposition of the great arteries, of whom 1742 (20%) underwent Rashkind procedure. Patients undergoing Rashkind procedure had lower mortality (10% versus 12%, p = 0.021), despite higher median co-morbidities and longer median length of stay. Rashkind procedure was not associated with increased risk of necrotising enterocolitis (1% versus 1%, p = 0.630), but was associated with nearly twice the risk of clinically recognised stroke (1% versus 0%, p = 0.046).

This study represents the largest national analysis of transposition of the great artery patients to date, with a subset treated with Rashkind procedure. Patients not undergoing Rashkind procedure had higher mortality. Rashkind procedure was not associated with increased risk of necrotising enterocolitis, but was associated with twice the risk of stroke.