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Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association's Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke Vasc Neurol 2017; 2:94-105. [PMID: 28959497 PMCID: PMC5600018 DOI: 10.1136/svn-2017-000092] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 01/06/2023] Open
Abstract
The American Heart Association’s Get With the Guidelines (GWTG)-Stroke programme has changed stroke care delivery in the USA since its establishment in 2003. GWTG is a voluntary registry and continuous quality improvement initiative that collects data on patient characteristics, hospital adherence to guidelines and inpatient outcomes. Implementation of the programme saw increased provision of evidence-based care and improved patient outcomes. This review will describe the development of the programme and discuss the impact on stroke outcomes and transformation of stroke care delivery that followed its implementation.
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Affiliation(s)
- Cora H Ormseth
- Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kevin N Sheth
- Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey L Saver
- Department of Neurology, UCLA Medical Center, Los Angeles, California, USA
| | - Gregg C Fonarow
- Department of Cardiology, UCLA Medical Center, Los Angeles, California, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Slezak A, Kurmann R, Oppliger L, Broeg-Morvay A, Gralla J, Schroth G, Mattle HP, Arnold M, Fischer U, Jung S, Greif R, Neff F, Mordasini P, Mono ML. Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever. AJNR Am J Neuroradiol 2017; 38:1362-1367. [PMID: 28473340 DOI: 10.3174/ajnr.a5183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE General anesthesia during endovascular treatment of acute ischemic stroke may have an adverse effect on outcome compared with conscious sedation. The aim of this study was to examine the impact of the type of anesthesia on the outcome of patients with acute ischemic stroke treated with the Solitaire stent retriever, accounting for confounding factors. MATERIALS AND METHODS Four-hundred one patients with consecutive acute anterior circulation stroke treated with a Solitaire stent retriever were included in this prospective analysis. Outcome was assessed after 3 months by the modified Rankin Scale. RESULTS One-hundred thirty-five patients (31%) underwent endovascular treatment with conscious sedation, and 266 patients (69%), with general anesthesia. Patients under general anesthesia had higher NIHSS scores on admission (17 versus 13, P < .001) and more internal carotid artery occlusions (44.6% versus 14.8%, P < .001) than patients under conscious sedation. Other baseline characteristics such as time from symptom onset to the start of endovascular treatment did not differ. Favorable outcome (mRS 0-2) was more frequent with conscious sedation (47.4% versus 32%; OR, 0.773; 95% CI, 0.646-0.925; P = .002) in univariable but not multivariable logistic regression analysis (P = .629). Mortality did not differ (P = .077). Independent predictors of outcome were age (OR, 0.95; 95% CI, 0.933-0.969; P < .001), NIHSS score (OR, 0.894; 95% CI, 0.855-0.933; P < .001), time from symptom onset to the start of endovascular treatment (OR, 0.998; 95% CI, 0.996-0.999; P = .011), diabetes mellitus (OR, 0.544; 95% CI, 0.305-0.927; P = .04), and symptomatic intracerebral hemorrhage (OR, 0.109; 95% CI, 0.028-0.428; P = .002). CONCLUSIONS In this single-center study, the anesthetic management during stent retriever thrombectomy with general anesthesia or conscious sedation had no impact on the outcome of patients with large-vessel occlusion in the anterior circulation.
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Affiliation(s)
- A Slezak
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - R Kurmann
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - L Oppliger
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - A Broeg-Morvay
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - J Gralla
- Diagnostic and Interventional Neuroradiology (J.G., G.S., P.M.)
| | - G Schroth
- Diagnostic and Interventional Neuroradiology (J.G., G.S., P.M.)
| | - H P Mattle
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - M Arnold
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - U Fischer
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - S Jung
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
| | - R Greif
- Anesthesiology and Pain Medicine (R.G., F.N.), University Hospital Bern and University of Bern, Bern, Switzerland
| | - F Neff
- Anesthesiology and Pain Medicine (R.G., F.N.), University Hospital Bern and University of Bern, Bern, Switzerland
| | - P Mordasini
- Diagnostic and Interventional Neuroradiology (J.G., G.S., P.M.)
| | - M-L Mono
- From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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103
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You S, Zhong C, Du H, Zhang Y, Zheng D, Wang X, Qiu C, Zhao H, Cao Y, Liu CF. Admission Low Magnesium Level Is Associated with In-Hospital Mortality in Acute Ischemic Stroke Patients. Cerebrovasc Dis 2017; 44:35-42. [PMID: 28419989 DOI: 10.1159/000471858] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Low magnesium levels are associated with an elevated risk of stroke. In this study, we investigated the association between magnesium levels on hospital admission and in-hospital mortality in acute ischemic stroke (AIS) patients. METHODS A total of 2,485 AIS patients, enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city, were included in this study. The patients were divided into 4 groups according to their level of admission magnesium: Q1 (<0.82 mmol/L), Q2 (0.82-0.89 mmol/L), Q3 (0.89-0.98 mmol/L), and Q4 (≥0.98 mmol/L). Cox proportional hazard model was used to estimate the effect of magnesium on all-cause in-hospital mortality in AIS patients. RESULTS During hospitalization, 92 patients (3.7%) died from all causes. The lowest serum magnesium level (Q1) was associated with a 2.66-fold increase in the risk of in-hospital mortality in comparison to Q4 (hazard ratio [HR] 2.66; 95% CI 1.55-4.56; p-trend < 0.001). After adjusting for age, sex, time from onset to hospital admission, baseline National Institutes of Health Stroke Scale score, and other potential covariates, HR for Q1 was 2.03 (95% CI 1.11-3.70; p-trend = 0.014). Sensitivity and subgroup analyses further confirmed a significant association between lower magnesium levels and a high risk of in-hospital mortality. CONCLUSIONS Decreased serum magnesium levels at admission were independently associated with in-hospital mortality in AIS patients.
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Affiliation(s)
- Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Xian Y, Federspiel JJ, Hernandez AF, Laskowitz DT, Schwamm LH, Bhatt DL, Smith EE, Fonarow GC, Peterson ED. Use of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke. Circulation 2017; 135:1024-1035. [DOI: 10.1161/circulationaha.116.023940] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/17/2017] [Indexed: 01/12/2023]
Abstract
Background:
Intravenous rt-PA (recombinant tissue-type plasminogen activator) is effective in improving outcomes in ischemic stroke; however, there are few data on the use of rt-PA in patients who are receiving a non–vitamin K antagonist oral anticoagulant (NOAC).
Methods:
Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we examined the outcomes of use of thrombolytic therapy in patients with ischemic stroke who received anticoagulation with NOACs versus those on warfarin (international normalized ratio <1.7) or not on anticoagulation from 1289 registry hospitals between October 2012 and March 2015.
Results:
Of 42 887 patients with ischemic stroke treated with intravenous rt-PA within 4.5 hours, 251 were taking NOACs (dabigatran 87, rivaroxaban 129, and apixaban 35) before their stroke, 1500 were taking warfarin, and 41 136 were on neither. Patients on NOACs or warfarin were older, had more comorbid conditions, and experienced more severe strokes than did those who were not on anticoagulation (median National Institutes of Health Stroke Scale 12, 13, and 9, respectively). Unadjusted rates of symptomatic intracranial hemorrhage in the NOAC, warfarin, and none groups were 4.8%, 4.9%, and 3.9%, respectively (
P
=0.11). In comparison with those not on anticoagulation, the adjusted odds ratio for symptomatic intracranial hemorrhage for those on NOACs was 0.92 (95% confidence interval, 0.51–1.65) and for those on warfarin the adjusted odds ratio was 0.85 (95% confidence interval, 0.66–1.10). There were also no significant differences in the risk for life-threatening/serious systemic hemorrhage, any rt-PA complication, in-hospital mortality, and modified Rankin Scale at discharge across 3 groups. Similar results were also found after propensity score matching.
Conclusions:
Although experience of using rt-PA in patients with ischemic stroke on a NOAC is limited, these preliminary observations suggest that rt-PA appears to be reasonably well tolerated without prohibitive risks for adverse events among selected NOAC-treated patients. Future studies should evaluate the safety and efficacy of intravenous rt-PA in patients with ischemic stroke who are taking NOACs.
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Affiliation(s)
- Ying Xian
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Jerome J. Federspiel
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Adrian F. Hernandez
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Daniel T. Laskowitz
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Lee H. Schwamm
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Deepak L. Bhatt
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Eric E. Smith
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Gregg C. Fonarow
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
| | - Eric D. Peterson
- From Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.); Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.); Division of Neurology Massachusetts General Hospital, Boston (L.H.S.); Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Clinical Neurosciences and Hotchkiss Brain Institute,
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Family discussions on life-sustaining interventions in neurocritical care. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:397-408. [PMID: 28187812 DOI: 10.1016/b978-0-444-63600-3.00022-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care. This process includes deciding whether to use life-sustaining treatments. Therefore, family discussion is a critical element in the decision-making process throughout the patient's stay in the neurocritical care unit. A large part of care in the neurosciences intensive care unit is discussion of proportionality of care. This chapter provides a stepwise approach to hold these conferences and discusses ways to do it effectively.
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106
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Choi EY, Kim SH, Ock M, Lee HJ, Son WS, Jo MW, Lee SI. Evaluation of the Validity of Risk-Adjustment Model of Acute Stroke Mortality for Comparing Hospital Performance. HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.4.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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107
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Hata J, Nagai A, Hirata M, Kamatani Y, Tamakoshi A, Yamagata Z, Muto K, Matsuda K, Kubo M, Nakamura Y, Kiyohara Y, Ninomiya T. Risk prediction models for mortality in patients with cardiovascular disease: The BioBank Japan project. J Epidemiol 2016; 27:S71-S76. [PMID: 28142037 PMCID: PMC5350588 DOI: 10.1016/j.je.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/26/2016] [Indexed: 11/21/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a leading cause of death in Japan. The present study aimed to develop new risk prediction models for long-term risks of all-cause and cardiovascular death in patients with chronic phase CVD. Methods Among the subjects registered in the BioBank Japan database, 15,058 patients aged ≥40 years with chronic ischemic CVD (ischemic stroke or myocardial infarction) were divided randomly into a derivation cohort (n = 10,039) and validation cohort (n = 5019). These subjects were followed up for 8.55 years in median. Risk prediction models for all-cause and cardiovascular death were developed using the derivation cohort by Cox proportional hazards regression. Their prediction performances for 5-year risk of mortality were evaluated in the validation cohort. Results During the follow-up, all-cause and cardiovascular death events were observed in 2962 and 962 patients from the derivation cohort and 1536 and 481 from the validation cohort, respectively. Risk prediction models for all-cause and cardiovascular death were developed from the derivation cohort using ten traditional cardiovascular risk factors, namely, age, sex, CVD subtype, hypertension, diabetes, total cholesterol, body mass index, current smoking, current drinking, and physical activity. These models demonstrated modest discrimination (c-statistics, 0.703 for all-cause death; 0.685 for cardiovascular death) and good calibration (Hosmer-Lemeshow χ2-test, P = 0.17 and 0.15, respectively) in the validation cohort. Conclusions We developed and validated risk prediction models of all-cause and cardiovascular death for patients with chronic ischemic CVD. These models would be useful for estimating the long-term risk of mortality in chronic phase CVD. We developed risk prediction models for death after cardiovascular disease (CVD). Performances of these models were validated in an independent cohort. Our models may be used to estimate mortality risk in chronic CVD patients.
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Affiliation(s)
- Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Nagai
- Department of Public Policy, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Makoto Hirata
- Laboratory of Genome Technology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
| | - Kaori Muto
- Department of Public Policy, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koichi Matsuda
- Laboratory of Molecular Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yusuke Nakamura
- Laboratory of Molecular Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Neurologic Functional Outcomes of Decompressive Hemicraniectomy Versus Conventional Treatment for Malignant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis. World Neurosurg 2016; 99:709-725.e3. [PMID: 28024976 DOI: 10.1016/j.wneu.2016.12.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate decompressive hemicraniectomy (DHC) versus conventional treatment (CT) for patients with malignant middle cerebral artery (MCA) infarction and to investigate the impact of age and surgical timing on neurologic function and mortality. METHODS We searched English and Chinese databases for randomized controlled trials or observational studies published before August 2016. Outcomes included good functional outcome (GFO), mortality, and National Institutes of Health Stroke Scale and Barthel index scores. RESULTS This meta-analysis included 25 studies (1727 patients). There were statistically significant differences between DHC and CT groups in terms of GFO (P < 0.0001), mortality (P < 0.00001), and National Institutes of Health Stroke Scale and Barthel index scores (P < 0.0001) at different follow-up points. Significant differences were observed between the groups in survival with moderately severe disability (P < 0.00001); no differences were observed in survival with severe disability. In the subgroup analysis, in the DHC group, GFO was less in patients >60 years old (9.65%) versus ≤60 years old (38.94%); more patients >60 years old had moderately severe or severe disability (55.27%) compared with patients ≤60 years old (44.21%). CONCLUSIONS DHC could significantly improve GFO and reduces mortality of patients of all ages with malignant MCA infarction compared with CT, without increasing the number of patients surviving with severe disability. However, patients in the DHC group more frequently had moderately severe disability. Patients >60 years old with malignant MCA infarction had a higher risk of surviving with moderately severe or severe disability and less GFO.
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Lee MJ, Chung JW, Ahn MJ, Kim S, Seok JM, Jang HM, Kim GM, Chung CS, Lee KH, Bang OY. Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study. J Stroke 2016; 19:77-87. [PMID: 28030894 PMCID: PMC5307941 DOI: 10.5853/jos.2016.00570] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/25/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose Patients with active cancer are at an increased risk for stroke. Hypercoagulability plays an important role in cancer-related stroke. We aimed to test whether 1) hypercoagulability is a predictor of survival, and 2) correction of the hypercoagulable state leads to better survival in patients with stroke and active cancer. Methods We recruited consecutive patients with acute ischemic stroke and active systemic cancer between January 2006 and July 2015. Hypercoagulability was assessed using plasma D-dimer levels before and after 7 days of anticoagulation treatment. The study outcomes included overall and 1-year survival. Plasma D-dimer levels before and after treatment were tested in univariate and multivariate Cox regression models. We controlled for systemic metastasis, stroke mechanism, age, stroke severity, primary cancer type, histology, and atrial fibrillation using the forward stepwise method. Results A total of 268 patients were included in the analysis. Patients with high (3rd–4th quartiles) pre-treatment plasma D-dimer levels showed decreased overall and 1-year survival (adjusted HR, 2.19 [95% CI, 1.46–3.31] and 2.70 [1.68–4.35], respectively). After anticoagulation treatment, post-treatment D-dimer level was significantly reduced and independently associated with poor 1-year survival (adjusted HR, 1.03 [95% CI, 1.01–1.05] per 1 μg/mL increase, P=0.015). The successful correction of hypercoagulability was a protective factor for 1-year survival (adjusted HR 0.26 [CI 0.10–0.68], P=0.006). Conclusions Hypercoagulability is associated with poor survival after stroke in patients with active cancer. Effective correction of hypercoagulability may play a protective role for survival in these patients.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seonwoo Kim
- Biostatistics Team, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Jin Myoung Seok
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Min Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Acute management of stroke patients taking non-vitamin K antagonist oral anticoagulants Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry: Design and rationale. Am Heart J 2016; 182:28-35. [PMID: 27914497 DOI: 10.1016/j.ahj.2016.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/21/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients. METHODS The ARAMIS Registry is a multicenter cohort study of acute stroke patients who were taking chronic anticoagulation therapy prior to admission and are admitted with either an acute ischemic stroke or intracerebral hemorrhage. Built upon the existing infrastructure of American Heart Association/American Stroke Association Get With the Guidelines Stroke, the ARAMIS Registry will enroll a total of approximately 10,000 patients (5000 with acute ischemic stroke who are taking a NOAC and 5000 with anticoagulation-related intracerebral hemorrhage who are on warfarin or a NOAC). The primary goals of the ARAMIS Registry are to provide a comprehensive picture of current treatment patterns and outcomes of acute ischemic stroke patients on NOACs, as well as anticoagulation-related intracerebral hemorrhage in patients on either warfarin or NOACs. Beyond characterizing the index hospitalization, up to 2500 patients (1250 ischemic stroke and 1250 intracerebral hemorrhage) who survive to discharge will be enrolled in an optional follow-up sub-study and interviewed at 3 and 6 months after discharge to assess longitudinal medication use, downstream care, functional status, and patient-reported outcomes. CONCLUSION The ARAMIS Registry will document the current state of management of NOAC treated patients with acute ischemic stroke as well as contemporary care and outcome of anticoagulation-related intracerebral hemorrhage. These data will be used to better understand optimal strategies to care for these complex but increasingly common emergent real world clinical challenges.
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Ali SF, Siddiqui K, Ay H, Silverman S, Singhal A, Viswanathan A, Rost N, Lev M, Schwamm LH. Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis. Stroke 2016; 47:2986-2992. [PMID: 27834750 DOI: 10.1161/strokeaha.116.014871] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/13/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have reported poor outcomes in patients too good to treat with intravenous thrombolysis because of mild or rapidly improving symptoms. We sought to determine baseline clinical and imaging predictors of poor outcome in these patients. METHODS Among 3950 consecutive stroke admissions (2009-2015) in our local Get With the Guidelines-Stroke database, 632 patients presented ≤4.5 hours and did not receive tissue-type plasminogen activator, with 380 of 632 (60.1%) being too good to treat. Univariate and multivariable analyses explored the clinical and imaging features associated with poor outcome (defined as not being discharged to home) in these 380 cases. RESULTS Among these 380 cases, only 68% were discharged home; the other 25% to inpatient rehabilitation, 4% to a skilled nursing facility, and 3% expired or were discharged to hospice. Patients with poor outcome were older, were more often Hispanic, had more vascular risk factors, and had higher median National Institutes of Health Stroke Scale. Imaging characteristics associated with poor outcomes included large or multifocal infarction and poor collaterals. In multivariable analysis, only age, initial National Institutes of Health Stroke Scale, and infarct location were independently associated with poor outcome. CONCLUSIONS Approximately one third of patients deemed too good for intravenous tissue-type plasminogen activator are unable to be discharged directly to home. Given the current safety profile of intravenous tissue-type plasminogen activator, our results suggest that the concept of being too good to treat should be re-examined with an emphasis on the features associated with poor outcome identified in our study. If replicated, these findings could be incorporated into tissue-type plasminogen activator decision-making algorithms.
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Affiliation(s)
- Syed F Ali
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Khawja Siddiqui
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Hakan Ay
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Scott Silverman
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Aneesh Singhal
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Natalia Rost
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Michael Lev
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Lee H Schwamm
- From the Department of Neurology, Massachusetts General Hospital, Boston.
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Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, Shen H, Liang L, Bettger J, Yang Q, Wang D, Wang A, Pan Y, Jiang Y, Yang X, Zhang C, Fonarow GC, Schwamm LH, Hu B, Peterson ED, Xian Y, Wang Y, Wang Y. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016; 47:2843-2849. [PMID: 27758941 DOI: 10.1161/strokeaha.116.014143] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. METHODS Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 patients) in China National Stroke Registries phase 2 from 2012 to 2013. Multiple regression models were developed to evaluate the difference in adherence to performance measure between the 2 study periods. RESULTS The overall quality of care has improved over time, as reflected by the higher composite score of 0.76 in 2012 to 2013 versus 0.63 in 2007 to 2008. Nine of 13 individual performance metrics improved. However, there were no significant improvements in the rates of intravenous thrombolytic therapy and anticoagulation for atrial fibrillation. After multivariate analysis, there remained a significant 1.17-fold (95% confidence interval, 1.14-1.21) increase in the odds of delivering evidence-based performance metrics in the more recent time periods versus older data. The performance metrics with the most significantly increased odds included stroke education, dysphagia screening, smoking cessation, and antithrombotics at discharge. CONCLUSIONS Adherence to stroke performance metrics has increased over time, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China.
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Affiliation(s)
- Zixiao Li
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Chunjuan Wang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Xingquan Zhao
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Liping Liu
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Chunxue Wang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Hao Li
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Haipeng Shen
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Li Liang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Janet Bettger
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Qing Yang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - David Wang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Anxin Wang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Yuesong Pan
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Yong Jiang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Xiaomeng Yang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Changqing Zhang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Gregg C Fonarow
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Lee H Schwamm
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Bo Hu
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Eric D Peterson
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Ying Xian
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.)
| | - Yilong Wang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.).
| | - Yongjun Wang
- From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.).
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Pandey AS, Meurer WJ, Chaudhary N, Gemmete JJ, Thompson BG, Morgenstern LB, Burke JF. Intra-arterial Stroke Treatment prior to the Stent-Retriever Era: High Mortality and Lack of Volume–Outcome Association. J Stroke Cerebrovasc Dis 2016; 25:2553-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/25/2016] [Indexed: 11/25/2022] Open
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Helmy TA, Abd-Elhady MAE, Abdou M. Prediction of Ischemic Stroke-Associated Pneumonia: A Comparison between 3 Scores. J Stroke Cerebrovasc Dis 2016; 25:2756-2761. [PMID: 27554074 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of death and disability worldwide. Among all poststroke complications, pneumonia constitutes a major complication with a strong impact on morbidity and mortality. To identify patients at high risk of stroke-associated pneumonia (SAP) and to tailor a prophylactic approach, a reliable scoring model for prediction may be useful in daily stroke care. OBJECTIVES This study aimed to compare the performance of the Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity (A2DS2) score, the acute ischemic stroke-associated pneumonia score (AIS-APS), and the Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) score in predicting SAP. METHODS Seventy consecutive patients with ischemic stroke admitted to the Critical Care Medicine Department of Alexandria Main University Hospital were included. Patients were prospectively followed up for primary outcome of pneumonia within the first 7 days after admission diagnosed by the Centers for Disease Control and Prevention criteria. Accuracy in predicting outcome measures was assessed by calculating the area under receiver operating characteristic curve (AUC). RESULTS Twenty-six (37.1%) patients developed pneumonia by the seventh day; the A2DS2 score AUC was .847 (95% CI: .741-.922), and the AIS-APS AUC was .798 (95% CI: .685-.884). The PANTHERIS score AUC was .715 (95% CI: .595-.817). The A2DS2 score AUC was significantly higher than the AIS-APS and the PANTHERIS score AUCs (P = .048 and P = .009 respectively), and the AIS-APS AUC was significantly higher than the PANTHERIS score AUC (P = .044). CONCLUSIONS The A2DS2 score is a valid tool for the prediction of SAP based on routinely collected data, and among the 3 studied scores, it shows the best performance in predicting SAP.
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Affiliation(s)
- Tamer Abdallah Helmy
- Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Mohammed Abdou
- Intensive Care Unit, Mamoura Chest Hospital, Alexandria, Egypt.
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Prognosis of Ischemic Stroke With Newly Diagnosed Diabetes Mellitus According to Hemoglobin A1c Criteria in Chinese Population. Stroke 2016; 47:2038-44. [DOI: 10.1161/strokeaha.116.013606] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/31/2016] [Indexed: 01/19/2023]
Abstract
Background and Purpose—
Hemoglobin A1c (HbA1c) was recommended to diagnose diabetes mellitus, but whether newly diagnosed diabetes mellitus (NDDM) according to the new criteria was associated with stroke prognosis was unclear. We aimed to investigate the prognosis of ischemic stroke with NDDM according to the new criteria.
Methods—
Ischemic stroke without a diabetes mellitus history in the survey on Abnormal Glucose Regulation in Patients With Acute Stroke Across China were included in the analysis. NDDM was defined as fasting plasma glucose ≥7.0 mmol/L, 2-hour oral glucose tolerance test ≥11.1 mmol/L, or HbA1c ≥6.5%, and NDDM was divided into group 1, diagnosed by glucose criteria (fasting plasma glucose ≥7.0 mmol/L or 2-hour oral glucose tolerance test ≥11.1 mmol/L with/without HbA1c ≥6.5%), or group 2, diagnosed by single high HbA1c (fasting plasma glucose <7.0 mmol/L, 2-hour oral glucose tolerance test <11.1 mmol/L, and HbA1c ≥6.5%). The association between NDDM and 1-year prognosis (mortality, stroke recurrence, and poor functional outcome [modified Rankin scale score 3–6]) was estimated.
Results—
Among 1251 ischemic stroke patients, 539 were NDDM and 141 of NDDM with single high HbA1c. NDDM was an independent risk factor for 1-year mortality (hazard ratio, 1.12; 95% confidence interval, 1.001–1.26), stroke recurrence (hazard ratio, 1.14; 95% confidence interval, 1.01–1.28), and poor functional outcome (odds ratio, 2.58; 95% confidence interval, 1.95–3.43) compared with non–diabetes mellitus. Nevertheless, NDDM with single high HbA1c was not significantly associated with 1-year prognosis for all end points (
P
>0.05 for all).
Conclusions—
NDDM by new criteria was associated with poor prognosis at 1 year after ischemic stroke; however, NDDM with single high HbA1c did not predict a poor prognosis.
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Myint PK, Hellkamp AS, Fonarow GC, Reeves MJ, Schwamm LH, Schulte PJ, Xian Y, Suter RE, Bhatt DL, Saver JL, Peterson ED, Smith EE. Prior Antithrombotic Use Is Associated With Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke. Stroke 2016; 47:2066-74. [PMID: 27435402 DOI: 10.1161/strokeaha.115.012414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/23/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Antithrombotics are the mainstay of treatment in primary and secondary prevention of stroke, and their use before an acute event may be associated with better outcomes. METHODS Using data from Get With The Guidelines-Stroke with over half a million acute ischemic strokes recorded between October 2011 and March 2014 (n=540 993) from 1661 hospitals across the United States, we examined the unadjusted and adjusted associations between previous antithrombotic use and clinical outcomes. RESULTS There were 250 104 (46%) stroke patients not receiving any antithrombotic before stroke; of whom approximately one third had a documented previous vascular indication. After controlling for clinical and hospital factors, patients who were receiving antithrombotics before stroke had better outcomes than those who did not, regardless of whether a previous vascular indication was present or not: adjusted odds ratio (95% confidence intervals) were 0.82 (0.80-0.84) for in-hospital mortality, 1.18 (1.16-1.19) for home as the discharge destination, 1.15 (1.13-1.16) for independent ambulatory status at discharge, and 1.15 (1.12-1.17) for discharge modified Rankin Scale score of 0 or 1. CONCLUSIONS Previous antithrombotic therapy was independently associated with improved clinical outcomes after acute ischemic stroke. Ensuring the use of antithrombotics in appropriate patient populations may be associated with benefits beyond stroke prevention.
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Affiliation(s)
- Phyo K Myint
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.).
| | - Anne S Hellkamp
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Gregg C Fonarow
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Matthew J Reeves
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Lee H Schwamm
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Phillip J Schulte
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Ying Xian
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Robert E Suter
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Deepak L Bhatt
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Jeffrey L Saver
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Eric D Peterson
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
| | - Eric E Smith
- From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom (P.K.M.); Duke Clinical Research Institute (A.S.H., P.J.S., Y.X.), and Division of Cardiology, Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC; Division of Cardiology, David Geffen School of Medicine at UCLA (G.C.F.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); American Heart Association, IFEM, University of Texas Southwestern, Dallas (R.E.S.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Stroke Program, Department of Neurology, David Geffen School of Medicine at UCLA (J.L.S.); and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AL, Canada (E.E.S.)
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Ho WM, Lin JR, Wang HH, Liou CW, Chang KC, Lee JD, Peng TY, Yang JT, Chang YJ, Chang CH, Lee TH. Prediction of in-hospital stroke mortality in critical care unit. SPRINGERPLUS 2016; 5:1051. [PMID: 27462499 PMCID: PMC4940351 DOI: 10.1186/s40064-016-2687-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/23/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Critical stroke causes high morbidity and mortality. We examined if variables in the early stage of critical stroke could predict in-hospital mortality. METHODS We recruited 611 ischemic and 805 hemorrhagic stroke patients who were admitted within 24 h after the symptom onset. Data were analyzed with independent t test and Chi square test, and then with multivariate logistic regression analysis. RESULTS In ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score (OR 1.08; 95 % CI 1.06-1.11; P < 0.01), white blood cell count (OR 1.11; 95 % CI 1.05-1.18; P < 0.01), systolic blood pressure (BP) (OR 0.49; 95 % CI 0.26-0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00-1.05; P = 0.03) were associated with in-hospital mortality. In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality. Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality. CONCLUSION Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.
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Affiliation(s)
- Wei-Min Ho
- />Dementia Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC
| | - Jr-Rung Lin
- />Clinical Informatics and Medical Statistics Research Center, Chang Gung University, No.261, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan, ROC
| | - Hui-Hsuan Wang
- />Department of Healthcare Management, College of Management, Chang Gung University, No.261, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan, ROC
| | - Chia-Wei Liou
- />Stroke Center and Department of Neurology, Kaohsiung Medical Center, Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833 Taiwan, ROC
| | - Ku-Chou Chang
- />Stroke Center and Department of Neurology, Kaohsiung Medical Center, Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833 Taiwan, ROC
| | - Jiann-Der Lee
- />Stroke Center and Department of Neurology, Chiayi Medical Center, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, 613 Chiayi County Taiwan, ROC
| | - Tsung-Yi Peng
- />Department of Neurology, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan, ROC
| | - Jen-Tsung Yang
- />Department of Neurosurgery, Chiayi Medical Center, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, 613 Chiayi County Taiwan, ROC
| | - Yeu-Jhy Chang
- />Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC
| | - Chien-Hung Chang
- />Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC
| | - Tsong-Hai Lee
- />Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC
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Cooray C, Mazya M, Bottai M, Dorado L, Skoda O, Toni D, Ford GA, Wahlgren N, Ahmed N. External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke. Stroke 2016; 47:1493-9. [DOI: 10.1161/strokeaha.116.012802] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
ASTRAL (Acute Stroke Registry and Analysis of Lausanne) and DRAGON (includes dense middle cerebral artery sign, prestroke modified Rankin Scale score, age, glucose, onset to treatment, National Institutes of Health Stroke Scale score) are 2 recently developed scores for predicting functional outcome after acute stroke in unselected acute ischemic stroke patients and in patients treated with intravenous thrombolysis, respectively. We aimed to perform external validation of these scores to assess their predictive performance in the large multicentre Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.
Methods—
We calculated the ASTRAL and DRAGON scores in 36 131 and 33 716 patients, respectively, registered in Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register between 2003 and 2013. The proportion of patients with 3-month modified Rankin Scale scores of 3 to 6 was observed for each score point and compared with the predicted proportion according to the risk scores. Calibration was assessed using calibration plots, and predictive performance was assessed using area under the curve of the receiver operating characteristic. Multivariate logistic regression coefficients for the variables in the 2 scores were compared with the original derivation cohorts.
Results—
The ASTRAL showed an area under the curve of 0.790 (95% confidence interval, 0.786–0.795) and the DRAGON an area under the curve of 0.774 (95% confidence interval, 0.769–0.779). All ASTRAL parameters except range of visual fields and all DRAGON parameters were significantly associated with functional outcome in multivariate analysis.
Conclusions—
The ASTRAL and DRAGON scores show an acceptable predictive performance. ASTRAL does not require imaging-data and therefore may have an advantage for the use in prehospital patient assessment. Prospective studies of both scores evaluating the impact of their use on patient outcomes after intravenous thrombolysis and endovascular therapy are needed.
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Affiliation(s)
- Charith Cooray
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Michael Mazya
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Matteo Bottai
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Laura Dorado
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Ondrej Skoda
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Danilo Toni
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Gary A. Ford
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Nils Wahlgren
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Niaz Ahmed
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
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Thompson MP, Luo Z, Gardiner J, Burke JF, Nickles A, Reeves MJ. Quantifying Selection Bias in National Institute of Health Stroke Scale Data Documented in an Acute Stroke Registry. Circ Cardiovasc Qual Outcomes 2016; 9:286-93. [PMID: 27166201 DOI: 10.1161/circoutcomes.115.002352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND As a measure of stroke severity, the National Institutes of Health Stroke Scale (NIHSS) is an important predictor of patient- and hospital-level outcomes, yet is often undocumented. The purpose of this study is to quantify and correct for potential selection bias in observed NIHSS data. METHODS AND RESULTS Data were obtained from the Michigan Stroke Registry and included 10 262 patients with ischemic stroke aged ≥65 years discharged from 23 hospitals from 2009 to 2012, of which 74.6% of patients had documented NIHSS. We estimated models predicting NIHSS documentation and NIHSS score and used the Heckman selection model to estimate a correlation coefficient (ρ) between the 2 model error terms, which quantifies the degree of selection bias in the documentation of NIHSS. The Heckman model found modest, but significant, selection bias (ρ=0.19; 95% confidence interval: 0.09, 0.29; P<0.001), indicating that because NIHSS score increased (ie, strokes were more severe), the probability of documentation also increased. We also estimated a selection bias-corrected population mean NIHSS score of 4.8, which was substantially lower than the observed mean NIHSS score of 7.4. Evidence of selection bias was also identified using hospital-level analysis, where increased NIHSS documentation was correlated with lower mean NIHSS scores (r=-0.39; P<0.001). CONCLUSIONS We demonstrate modest, but important, selection bias in documented NIHSS data, which are missing more often in patients with less severe stroke. The population mean NIHSS score was overestimated by >2 points, which could significantly alter the risk profile of hospitals treating patients with ischemic stroke and subsequent hospital risk-adjusted outcomes.
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Affiliation(s)
- Michael P Thompson
- From the Department of Epidemiology and Biostatistics, Michigan State University, Lansing (M.P.T., Z.L., J.G., M.J.R.); Department of Neurology, University of Michigan, Ann Arbor (J.M.B.); and Chronic Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing (A.N.).
| | - Zhehui Luo
- From the Department of Epidemiology and Biostatistics, Michigan State University, Lansing (M.P.T., Z.L., J.G., M.J.R.); Department of Neurology, University of Michigan, Ann Arbor (J.M.B.); and Chronic Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing (A.N.)
| | - Joseph Gardiner
- From the Department of Epidemiology and Biostatistics, Michigan State University, Lansing (M.P.T., Z.L., J.G., M.J.R.); Department of Neurology, University of Michigan, Ann Arbor (J.M.B.); and Chronic Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing (A.N.)
| | - James F Burke
- From the Department of Epidemiology and Biostatistics, Michigan State University, Lansing (M.P.T., Z.L., J.G., M.J.R.); Department of Neurology, University of Michigan, Ann Arbor (J.M.B.); and Chronic Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing (A.N.)
| | - Adrienne Nickles
- From the Department of Epidemiology and Biostatistics, Michigan State University, Lansing (M.P.T., Z.L., J.G., M.J.R.); Department of Neurology, University of Michigan, Ann Arbor (J.M.B.); and Chronic Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing (A.N.)
| | - Mathew J Reeves
- From the Department of Epidemiology and Biostatistics, Michigan State University, Lansing (M.P.T., Z.L., J.G., M.J.R.); Department of Neurology, University of Michigan, Ann Arbor (J.M.B.); and Chronic Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing (A.N.)
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121
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Almekhlafi MA. Trends in one-year mortality for stroke in a tertiary academic center in Saudi Arabia: a 5-year retrospective analysis. Ann Saudi Med 2016; 36:197-202. [PMID: 27236391 PMCID: PMC6074538 DOI: 10.5144/0256-4947.2016.197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Numerous studies have reported a decline in stroke-related mortality in developed countries. OBJECTIVE To assess trends in one-year mortality following a stroke diagnosis in Saudi Arabia. DESIGN Retrospective longitudinal cohort study. SETTING Single tertiary care center from 2010 through 2014. PATIENTS All patients admitted with a primary admitting diagnosis of stroke. METHODS Demographic data (age, gender, nationality), risk factor profile, stroke subtypes, in-hospital complications and mortality data as well as cause of death were collected for all patients. A multivariable logistic regression model was used to assess factors associated with one-year mortality following a stroke admission. MAIN OUTCOME MEASURE(S) One-year mortality. RESULTS In 548 patients with a mean age of 62.9 years (SD 16.9), the most frequent vascular risk factors were hypertension (90.6%), diabetes (65.5%), and hyperlipidemia (27.2%). Hemorrhagic stroke was diagnosed in 9.9%. The overall mortality risk was 26.9%. Non-Saudis had a significantly higher one-year mortality risk compared with Saudis (25% vs. 16.8%, respectively; P=.025). The most frequently reported causes of mortality were neurological and related to the underlying stroke (32%), sepsis (30%), and cardiac or other organ dysfunction-related (each 9%) in addition to other etiologies (collectively 9.5%) such as pulmonary embolism or an underlying malignancy. Significant predictors in the multivariate model were age (P < .0001), non-Saudi nationality (OR 1.8, CI 95 1.1 to 2.9; P=.019), and hospital length of stay (OR 1.01, CI 95 1 to 1.004; P=.001). CONCLUSION We observed no decline in stroke mortality in our center over the 5-year span. The establishment of stroke systems of care, use of thrombolytic agents, and opening of a stroke unit should play an important role in a decline in stroke mortality. LIMITATIONS Retrospective single center study. Mortality data were available only for patients who died in our hospital.
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Affiliation(s)
- Mohammed A Almekhlafi
- Dr. Mohammed Almekhlafi, Department of Internal Medicine,, Division of Neurology,, King Abdulaziz University,, PO Box 80215, Jeddah, 21589, Saudi Arabia, , ORCID ID: orcid.org/0000-0001-9550-8197
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Bustamante A, García-Berrocoso T, Rodriguez N, Llombart V, Ribó M, Molina C, Montaner J. Ischemic stroke outcome: A review of the influence of post-stroke complications within the different scenarios of stroke care. Eur J Intern Med 2016; 29:9-21. [PMID: 26723523 DOI: 10.1016/j.ejim.2015.11.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/28/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022]
Abstract
Stroke remains one of the main causes of death and disability worldwide. The challenge of predicting stroke outcome has been traditionally assessed from a general point of view, where baseline non-modifiable factors such as age or stroke severity are considered the most relevant factors. However, after stroke occurrence, some specific complications such as hemorrhagic transformations or post stroke infections, which lead to a poor outcome, could be developed. An early prediction or identification of these circumstances, based on predictive models including clinical information, could be useful for physicians to individualize and improve stroke care. Furthermore, the addition of biological information such as blood biomarkers or genetic polymorphisms over these predictive models could improve their prognostic value. In this review, we focus on describing the different post-stroke complications that have an impact in short and long-term outcome across different time points in its natural history and on the clinical-biological information that might be useful in their prediction.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Noelia Rodriguez
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victor Llombart
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain; Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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123
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Using Radiological Data to Estimate Ischemic Stroke Severity. J Stroke Cerebrovasc Dis 2016; 25:792-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022] Open
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The A2DS2 Score as a Predictor of Pneumonia and In-Hospital Death after Acute Ischemic Stroke in Chinese Populations. PLoS One 2016; 11:e0150298. [PMID: 26950337 PMCID: PMC4780726 DOI: 10.1371/journal.pone.0150298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/11/2016] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Stroke-associated pneumonia (SAP) is a common complication and an important cause of death during hospitalization. The A2DS2 (Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity) score was developed from the Berlin Stroke Registry and showed good predictive value for predicting SAP. We sought to identify the association between the A2DS2 score and SAP, and, furthermore, to identify whether the A2DS2 score was a predictor for in-hospital death after acute ischemic stroke in a Chinese population. Methods This was a retrospective study. 1239 acute ischemic stroke patients were classified to low A2DS2 group (0–4) and high A2DS2 score (5–10) group. Primary outcome was in-hospital SAP. Logistic regression analyses were performed to identify the association between the A2DS2 score and SAP, and also the association between the A2DS2 score and in-hospital death. Results The overall incidence rates of SAP and in-hospital mortality after acute ischemic stroke were 7.3% and 2.4%, respectively. The incidence rate of SAP in low and high A2DS2 score groups was separately 3.3% and 24.7% (P<0.001). During hospitalization, 1.2% patients in low score group and 7.8% patients in high score group died (P<0.001). Multivariate regression demonstrated that patients in high score group had a higher risk of SAP (OR = 8.888, 95%CI: 5.552–14.229) and mortality (OR = 7.833, 95%CI: 3.580–17.137) than patients in low score group. Conclusions The A2DS2 score was a strong predictor for SAP and in-hospital death of Chinese acute ischemic stroke patients. The A2DS2 score might be a useful tool for the identification of patients with a high risk of SAP and death during hospitalization.
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Xu J, Tao Y, Xie X, Liu G, Wang A, Wang Y, Wang Y. A Comparison of Mortality Prognostic Scores in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2016; 25:241-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/07/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022] Open
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Mattishent K, Kwok CS, Mahtani A, Pelpola K, Myint PK, Loke YK. Prognostic indices for early mortality in ischaemic stroke - meta-analysis. Acta Neurol Scand 2016; 133:41-8. [PMID: 25968234 DOI: 10.1111/ane.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. METHODS We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003 and 2014) used in predicting early mortality (<6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic curve (AUROC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways and missing data. RESULTS We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for meta-analysis. Most studies were either retrospective, or post hoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82-0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE - these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78-0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72-0.72) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84-0.87). CONCLUSIONS Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base.
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Affiliation(s)
- K. Mattishent
- Norwich Medical School; University of East Anglia; Norwich UK
| | - C. S. Kwok
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. Mahtani
- Norwich Medical School; University of East Anglia; Norwich UK
| | - K. Pelpola
- Southend University Hospital Trust; Westcliff-on-Sea UK
| | - P. K. Myint
- Epidemiology Group; Institute of Applied Health Sciences; School of Medicine & Dentistry; University of Aberdeen; Aberdeen UK
| | - Y. K. Loke
- Norwich Medical School; University of East Anglia; Norwich UK
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Abdul-Rahim AH, Quinn TJ, Alder S, Clark AB, Musgrave SD, Langhorne P, Potter JF, Myint PK. Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. Stroke 2016; 47:74-9. [DOI: 10.1161/strokeaha.115.009898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/22/2015] [Indexed: 01/02/2023]
Abstract
Background and Purpose—
The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.
Methods—
Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer–Lemeshow goodness-of-fit test.
Results—
A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75–0.84) and 0.83 (95% confidence interval, 0.79–0.86), respectively (
P
=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82–0.88) for outcome of early mortality. Calibration was good (
P
=0.70 for the Hosmer–Lemeshow test).
Conclusions—
Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.
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Affiliation(s)
- Azmil H. Abdul-Rahim
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - Terence J. Quinn
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - Sarah Alder
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - Allan B. Clark
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - Stanley D. Musgrave
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - Peter Langhorne
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - John F. Potter
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
| | - Phyo Kyaw Myint
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., T.J.Q., P.L.); Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom (S.A.); Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (A.B.C., S.D.M., J.F.P.); and Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom (P.K.M.)
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Sung SF, Chen SCC, Hsieh CY, Li CY, Lai ECC, Hu YH. A comparison of stroke severity proxy measures for claims data research: a population-based cohort study. Pharmacoepidemiol Drug Saf 2015; 25:438-43. [PMID: 26696591 DOI: 10.1002/pds.3944] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE Confounding by disease severity has been viewed as an intractable problem in claims-based studies. A novel 7-variable stroke severity index (SSI) was designed for estimating stroke severity by using claims data. This study compared the performance of mortality models with various proxy measures of stroke severity, including the SSI, in patients hospitalized for acute ischemic stroke (AIS). METHODS Data from the Taiwan National Health Insurance Research Database (NHIRD) were analyzed. Three proxy measures of stroke severity were evaluated: Measure 1, the SSI; Measure 2, intensive care unit admission and length of stay; and Measure 3, surgical operation, mechanical ventilation, hemiplegia or hemiparesis, and residual neurological deficits. We performed logistic regression by including age, sex, vascular risk factors, Charlson comorbidity index, and one of the proxy measures as covariates to predict 30-day and 1-year mortality after AIS. Model discrimination was evaluated using the area under the receiver-operating characteristic curve (AUC). RESULTS We identified 7551 adult patients with AIS. Models using the SSI (Measure 1) outperformed models using the other proxy measures in predicting 30-day mortality (AUC 0.892 vs 0.851, p < 0.001 for Measure 2; 0.892 vs 0.853, p < 0.001 for Measure 3) and 1-year mortality (AUC 0.816 vs 0.784, p < 0.001 for Measure 2; 0.816 vs 0.782, p < 0.001 for Measure 3). CONCLUSIONS Using the SSI facilitated risk adjustment for stroke severity in mortality models for patients with AIS. The SSI is a viable methodological tool for stroke outcome studies using the NHIRD.
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Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan City, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Edward Chia-Cheng Lai
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ya-Han Hu
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan
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129
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Integrating Palliative Care Into the Care of Neurocritically Ill Patients: A Report From the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care. Crit Care Med 2015; 43:1964-77. [PMID: 26154929 DOI: 10.1097/ccm.0000000000001131] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. DATA SOURCES A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury." DATA EXTRACTION AND SYNTHESIS We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. CONCLUSIONS Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.
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130
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Reeves MJ, Smith EE, Fonarow GC, Zhao X, Thompson M, Peterson ED, Schwamm LH, Olson D. Variation and Trends in the Documentation of National Institutes of Health Stroke Scale in GWTG-Stroke Hospitals. Circ Cardiovasc Qual Outcomes 2015; 8:S90-8. [DOI: 10.1161/circoutcomes.115.001775] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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132
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Ali SF, Smith EE, Reeves MJ, Zhao X, Xian Y, Hernandez AF, Bhatt DL, Fonarow GC, Schwamm LH. Smoking Paradox in Patients Hospitalized With Coronary Artery Disease or Acute Ischemic Stroke. Circ Cardiovasc Qual Outcomes 2015; 8:S73-80. [DOI: 10.1161/circoutcomes.114.001244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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133
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Lee SY, Chou CL, Hsu SPC, Shih CC, Yeh CC, Hung CJ, Chen TL, Liao CC. Outcomes after Stroke in Patients with Previous Pressure Ulcer: A Nationwide Matched Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2015; 25:220-7. [PMID: 26500174 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/15/2015] [Accepted: 09/19/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Factors associated with poststroke adverse events were not completely understood. The purpose of this study was to investigate whether stroke patients with previous pressure ulcers had more adverse events after stroke. METHODS Using the claims data from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study matched by propensity score. Three thousand two first-ever stroke patients with previous pressure ulcer and 3002 first-ever stroke patients without pressure ulcer were investigated between 2002 and 2009. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of complications and 30-day mortality after stroke associated with previous pressure ulcer were calculated in the multivariate logistic regressions. RESULTS Patients with pressure ulcer had significantly higher risk than control for poststroke urinary tract infection (OR: 1.56, 95% CI: 1.38-1.78), pneumonia (OR: 1.35, 95% CI: 1.16-1.58), gastrointestinal bleeding (OR: 1.31, 95% CI: 1.04-1.66), and epilepsy (OR: 1.84, 95% CI: 1.83-1.85). Stroke patients with pressure ulcer had increased 30-day poststroke mortality (OR: 2.01, 95% CI: 1.55-2.61), particularly in those treated with debridement (OR: 2.87, 95% CI: 1.85-4.44) or high quantity of antibiotics (OR: 4.01, 95% CI: 2.10-7.66). Pressure ulcer was associated with poststroke mortality in both genders and patients aged 60 years or older. CONCLUSIONS This study showed increased poststroke complications and mortality in patients with previous pressure ulcer, which suggests the urgent need for monitoring stroke patients for pressure ulcer history.
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Affiliation(s)
- Shang-Yi Lee
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Lun Chou
- Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Sanford P C Hsu
- Neurosurgery Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan; Ph.D. Program for Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, University of Illinois, Chicago, Illinois
| | - Chih-Jen Hung
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ta-Liang Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Chang Liao
- School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Nakibuuka J, Sajatovic M, Nankabirwa J, Ssendikadiwa C, Furlan AJ, Katabira E, Kayima J, Kalema N, Byakika-Tusiime J, Ddumba E. Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up. SPRINGERPLUS 2015; 4:450. [PMID: 26322256 PMCID: PMC4547979 DOI: 10.1186/s40064-015-1252-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 08/15/2015] [Indexed: 12/01/2022]
Abstract
Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic stroke and 39 (30.7 %) had hemorrhagic stroke. Eight (6.3 %) died within 7 days, 34 (26.8 %) died within 30 days, with 2/3 of deaths occurring in hospital. Two were lost to follow up. Of 91 survivors, 49 (53.9 %) had satisfactory outcome, 42 (46.1 %) had poor functional outcome. At multivariate analysis, independent predictors of mortality at 30 days were unconsciousness (GCS <9), severe stroke at admission and elevated fasting blood sugar. None of the patients with functional independence (Barthel index ≥60) at admission died within 30 days. Inverse independent predictors of satisfactory outcome at 30 days were older age, history of hypertension and severe stroke at admission. Acute stroke patients in Uganda still have high rates of early mortality and poor functional outcomes. Independent predictors of mortality and poor functional outcome were severe stroke at admission, unconsciousness, high fasting blood sugar, old age and history of hypertension.
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Affiliation(s)
- Jane Nakibuuka
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7051, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA
| | - Joaniter Nankabirwa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7051, Kampala, Uganda
| | - Charles Ssendikadiwa
- Department of Medicine, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Anthony J Furlan
- University Hospitals Case Medical Center, Neurological Institute Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106 USA
| | - Elly Katabira
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7051, Kampala, Uganda
| | - James Kayima
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7051, Kampala, Uganda
| | - Nelson Kalema
- Department of Medicine, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Jayne Byakika-Tusiime
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Edward Ddumba
- Department of Medicine, St Raphael of St Francis Nsambya Hospital, Nkozi University, P.O. Box 7146, Kampala, Uganda
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Xian Y, Wu J, O'Brien EC, Fonarow GC, Olson DM, Schwamm LH, Bhatt DL, Smith EE, Suter RE, Hannah D, Lindholm B, Maisch L, Greiner MA, Lytle BL, Pencina MJ, Peterson ED, Hernandez AF. Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study. BMJ 2015; 351:h3786. [PMID: 26232340 PMCID: PMC4521370 DOI: 10.1136/bmj.h3786] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the association between warfarin treatment and longitudinal outcomes after ischemic stroke in patients with atrial fibrillation in community practice. DESIGN Observational study. SETTING Hospitals (n = 1487) participating in the Get With The Guidelines (GWTG)-Stroke program in the United States, from 2009 to 2011. PARTICIPANTS 12,552 warfarin naive atrial fibrillation patients admitted to hospital for ischemic stroke and treated with warfarin compared with no oral anticoagulant at discharge, linked to Medicare claims for longitudinal outcomes. MAIN OUTCOME MEASURES Major adverse cardiovascular events (MACE) and home time, a patient centered outcomes measure defined as the total number of days free from institutional care after discharge. A propensity score inverse probability weighting method was used to account for all differences in observed characteristics between treatment groups. RESULTS Among 12,552 survivors of stroke, 11,039 (88%) were treated with warfarin at discharge. Warfarin treated patients were slightly younger and less likely to have a history of previous stroke or coronary artery disease but had similar severity of stroke as measured by the National Institutes of Health Stroke Scale. Relative to those not treated, patients treated with warfarin had more days at home (as opposed to institutional care) during the two years after discharge (adjusted home time difference 47.6 days, 99% confidence interval 26.9 to 68.2). Patients discharged on warfarin treatment also had a reduced risk of MACE (adjusted hazard ratio 0.87, 99% confidence interval 0.78 to 0.98), all cause mortality (0.72, 0.63 to 0.84), and recurrent ischemic stroke (0.63, 0.48 to 0.83). These differences were consistent among clinically relevant subgroups by age, sex, stroke severity, and history of previous coronary artery disease and stroke. CONCLUSIONS Among ischemic stroke patients with atrial fibrillation, warfarin treatment was associated with improved long term clinical outcomes and more days at home. Clinical trial registration Clinical trials NCT02146274.
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Affiliation(s)
- Ying Xian
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Jingjing Wu
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Emily C O'Brien
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, CA, USA
| | - DaiWai M Olson
- Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lee H Schwamm
- Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Robert E Suter
- The American Heart Association and University of Texas Southwestern, Dallas, TX, USA
| | - Deidre Hannah
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA Division of Cardiology, University of California, Los Angeles, CA, USA Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada The American Heart Association and University of Texas Southwestern, Dallas, TX, USA
| | - Brianna Lindholm
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA Division of Cardiology, University of California, Los Angeles, CA, USA Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada The American Heart Association and University of Texas Southwestern, Dallas, TX, USA
| | - Lesley Maisch
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA Division of Cardiology, University of California, Los Angeles, CA, USA Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada The American Heart Association and University of Texas Southwestern, Dallas, TX, USA
| | - Melissa A Greiner
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Barbara L Lytle
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Michael J Pencina
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
| | - Eric D Peterson
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA
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Lack of impact of electronic health records on quality of care and outcomes for ischemic stroke. J Am Coll Cardiol 2015; 65:1964-72. [PMID: 25953748 DOI: 10.1016/j.jacc.2015.02.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Electronic health records (EHRs) may be key tools for improving the quality of health care, particularly for conditions for which guidelines are rapidly evolving and timely care is critical, such as ischemic stroke. OBJECTIVES The goal of this study was to determine whether hospitals with EHRs differed on quality or outcome measures for ischemic stroke from those without EHRs. METHODS We studied 626,473 patients from 1,236 U.S. hospitals in Get With the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, linked with the American Hospital Association annual survey to determine the presence of EHRs. We conducted patient-level logistic regression analyses for each of the outcomes of interest. RESULTS A total of 511 hospitals had EHRs by the end of the study period. Hospitals with EHRs were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving "all-or-none" care (odds ratio [OR]: 1.03; 95% CI: 0.99 to 1.06; p=0.12), of discharge home (OR: 1.02; 95% CI: 0.99 to 1.04; p=0.15), and of in-hospital mortality (OR: 1.01; 95% CI: 0.96 to 1.05; p=0.82). The odds of having a length of stay>4 days was slightly lower at hospitals with EHRs (OR: 0.97; 95% CI: 0.95 to 0.99; p=0.01). CONCLUSIONS In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes for stroke care. Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease.
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Souter MJ, Blissitt PA, Blosser S, Bonomo J, Greer D, Jichici D, Mahanes D, Marcolini EG, Miller C, Sangha K, Yeager S. Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management. Neurocrit Care 2015; 23:4-13. [DOI: 10.1007/s12028-015-0137-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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138
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Kim SH, Lee HJ. Factors Affecting the Outcome Indicators in Patients with Stroke. HEALTH POLICY AND MANAGEMENT 2015. [DOI: 10.4332/kjhpa.2015.25.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Park JH, Ovbiagele B. Neurologic symptom severity after a recent noncardioembolic stroke and recurrent vascular risk. J Stroke Cerebrovasc Dis 2015; 24:1032-7. [PMID: 25817617 DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/08/2014] [Accepted: 12/29/2014] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND There is a well-established relation of symptom severity with functional status and mortality after an index stroke. However, little is known about the impact of symptom severity of a recent index stroke on risk of recurrent vascular events. METHODS We reviewed the data set of a multicenter trial involving 3680 recent noncardioembolic stroke patients aged 35 years or older and followed for 2 years. Independent associations of stroke severity (as measured by National Institutes of Health Stroke Scale [NIHSS] score) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. NIHSS score was analyzed as a dichotomous (<4 versus ≥4) and a continuous variable. RESULTS Among study subjects, 550 (15%) had NIHSS scores of 4 or more (overall scores ranged from 0 to 18, median score was 1 [25th-75th percentile 0-2]). NIHSS was measured at a median of 35 days after the index stroke. After adjusting for multiple covariates, NIHSS of 4 or more was independently linked to a higher risk of recurrent stroke (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.01-1.84) and risk of stroke/CHD/vascular death (HR, 1.32; 95% CI, 1.07-1.64). Analysis of NIHSS score as a continuous variable also showed a higher risk of recurrent stroke (HR, 1.06; 95% CI, 1.00-1.12) and stroke/CHD/vascular death (HR, 1.05; 95% CI, 1.01-1.09) with increasing index stroke symptom severity. CONCLUSIONS Greater residual symptom severity after a recent stroke is associated with higher risk of recurrent vascular events. Future studies are needed to confirm this relationship and to clarify its underlying mechanisms.
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Affiliation(s)
- Jong-Ho Park
- Department of Stroke Neurology, Myongji Hospital, Goyang, Korea; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
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Ntaios G, Papavasileiou V, Michel P, Tatlisumak T, Strbian D. Predicting functional outcome and symptomatic intracranial hemorrhage in patients with acute ischemic stroke: a glimpse into the crystal ball? Stroke 2015; 46:899-908. [PMID: 25657189 DOI: 10.1161/strokeaha.114.003665] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George Ntaios
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Vasileios Papavasileiou
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Patrik Michel
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Turgut Tatlisumak
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.)
| | - Daniel Strbian
- From the Department of Medicine, University of Thessaly, Larissa, Greece (G.N., V.P.); Neurology Service, University of Lausanne, Lausanne, Switzerland (P.M.); and Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., D.S.).
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Wang MD, Wang Y, Xia YP, Dai JW, Gao L, Wang SQ, Wang HJ, Mao L, Li M, Yu SM, Tu Y, He QW, Zhang GP, Wang L, Xu GZ, Xu HB, Zhu LQ, Hu B. High Serum MiR-130a Levels Are Associated with Severe Perihematomal Edema and Predict Adverse Outcome in Acute ICH. Mol Neurobiol 2015; 53:1310-1321. [PMID: 25631713 DOI: 10.1007/s12035-015-9099-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/12/2015] [Indexed: 12/12/2022]
Abstract
The development and/or progression of perihematomal edema (PHE) in patients with acute spontaneous intracerebral hemorrhage (ICH) vary substantially with different individuals. Although hematoma volume is a useful indicator for predicting PHE, its predictive power was not good at the early stage of ICH. Better predictors are urgently needed. In this study, we found that miR-130a was elevated in the serum of ICH patients and was an independent indicator positively associated with PHE volume within the first 3 days after onset. The R (2) was further evaluated when it is used in combination with hematoma mass. Serum miR-130a levels were associated with clinical outcome (National Institute of Health Stroke Scale (NIHSS) scores at day 14 and modified Rankin Scale (mRS) scores at day 90) only in patients with deep hematoma. Moreover, miR-130a was significantly increased in rat serum and perihematomal tissues and was in line with the change in brain edema. MiR-130a inhibitors reduced brain edema, blood-brain barrier (BBB) permeability, and increased neurological deficit scores, and miR-130a mimics increased monolayer permeability. Thrombin-stimulated brain microvascular endothelial cells (BMECs) were a main source of miR-130a under ICH. In the experimental model, the elevated miR-130a level was accompanied by the decreased caveolin-1 and increased matrix metalloproleinase (MMP)-2/9. Meanwhile, caveolin-1 (cav-1) was reduced by miR-130a mimics, accompanied by an increase in MMP-2/9 expression. The upregulated MMP-2/9 was then downregulated by cavtratin, a cav-1 scaffolding domain peptide. This regulation mechanism was authenticated in a thrombin-induced cellular ICH model. Our results suggest that serum miR-130a may serve as a useful early biomarker for monitoring post-ICH PHE and predicting prognosis and may be helpful in the decision-making of individualized therapy.
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Affiliation(s)
- Meng-Die Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Yong Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Yuan-Peng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Jing-Wen Dai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Lin Gao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Si-Qi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Hai-Jun Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Shi-Meng Yu
- Department of Neurology, The Attached Hospital of Xinyang Vocational Technical College, Daqing Road, Xinyang, 464000, People's Republic of China
| | - Yan Tu
- Department of Geratology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Donghu Road, Wuhan, 430077, People's Republic of China
| | - Quan-Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Guo-Peng Zhang
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Lei Wang
- Department of Neurosurgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Guo-Zheng Xu
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Command, Wuluo Road, Wuhan, 430070, People's Republic of China
| | - Hai-Bo Xu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China
| | - Ling-Qiang Zhu
- Department of Pathophysiology, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, People's Republic of China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430022, People's Republic of China. .,Key Laboratory of Neurological Disease, Ministry of Education, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, People's Republic of China.
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Lichtman JH, Leifheit-Limson EC, Goldstein LB. Centers for medicare and medicaid services medicare data and stroke research: goldmine or landmine? Stroke 2015; 46:598-604. [PMID: 25593137 DOI: 10.1161/strokeaha.114.003255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith H Lichtman
- From the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.H.L., E.C.L.-L.); and Department of Neurology, Duke Stroke Center, Duke University and Durham VAMC, Durham, NC (L.B.G.).
| | - Erica C Leifheit-Limson
- From the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.H.L., E.C.L.-L.); and Department of Neurology, Duke Stroke Center, Duke University and Durham VAMC, Durham, NC (L.B.G.)
| | - Larry B Goldstein
- From the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.H.L., E.C.L.-L.); and Department of Neurology, Duke Stroke Center, Duke University and Durham VAMC, Durham, NC (L.B.G.)
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143
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Ido MS, Bayakly R, Frankel M, Lyn R, Okosun IS. Administrative data linkage to evaluate a quality improvement program in acute stroke care, Georgia, 2006-2009. Prev Chronic Dis 2015; 12:E05. [PMID: 25590599 PMCID: PMC4307832 DOI: 10.5888/pcd12.140238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Tracking the vital status of stroke patients through death data is one approach to assessing the impact of quality improvement in stroke care. We assessed the feasibility of linking Georgia hospital discharge data with mortality data to evaluate the effect of participation in the Georgia Coverdell Acute Stroke Registry on survival rates among acute ischemic stroke patients. Methods Multistage probabilistic matching, using a fine-grained record integration and linkage software program and combinations of key variables, was used to link Georgia hospital discharge data for 2005 through 2009 with mortality data for 2006 through 2010. Data from patients admitted with principal diagnoses of acute ischemic stroke were analyzed by using the extended Cox proportional hazard model. The survival times of patients cared for by hospitals participating in the stroke registry and of those treated at nonparticipating hospitals were compared. Results Average age of the 50,579 patients analyzed was 69 years, and 56% of patients were treated in Georgia Coverdell Acute Stroke Registry hospitals. Thirty-day and 365-day mortality after first admission for stroke were 8.1% and 18.5%, respectively. Patients treated at nonparticipating facilities had a hazard ratio for death of 1.14 (95% confidence interval, 1.03–1.26; P = .01) after the first week of admission compared with patients cared for by hospitals participating in the registry. Conclusion Hospital discharge data can be linked with death data to assess the impact of clinical-level or community-level chronic disease control initiatives. Hospitals need to undertake quality improvement activities for a better patient outcome.
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Affiliation(s)
- Moges Seyoum Ido
- Georgia Department of Public Health, 2 Peachtree St, NW, Suite 14-277, Atlanta, GA 30303-3142. E-mail:
| | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, Georgia
| | | | - Rodney Lyn
- Georgia State University, Atlanta, Georgia
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Suzuki K, Aoki J, Kanzawa T, Nishiyama Y, Takayama Y, Kimura H, Takahashi S, Kano T, Akaji K, Tanizaki Y, Kimura K, Mihara B. Correlation between the Occlusion Site and Clinical Outcome after Acute Ischemic Stroke. Intern Med 2015; 54:3139-44. [PMID: 26666600 DOI: 10.2169/internalmedicine.54.4990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The significance of early mild clinical improvement after intravenous tissue plasminogen activator (IVtPA) treatment is unclear. Therefore, we examined whether the timing of clinical improvement after IVtPA predicted the clinical outcome at 3 months. METHODS Consecutive patients with acute cerebral infarction in the anterior circulation who received IVtPA treatment within 3 hours of the onset of symptoms were enrolled in the study. Patients were classified according to the timing of clinical improvement [early responder (ER), National Institutes of Health Stroke Scale (NIHSS) score improved ≥4 points or who had a score of 0 within 2 hours after IVtPA; late responder (LR), a similar improvement between 2 and 24 hours; and non-responder (NR)] and according to the arterial occlusion site (P group, internal carotid artery and proximal middle cerebral artery M1 region; and D group, distal M1 and M2). RESULTS Ninety-three patients [median age, 74 (67-79) years; 54 men (58%); median NIHSS score, 11 (7-16)] were enrolled in the study. The P group consisted of 48 (52%) patients and the D group consisted of 45 (48%) patients. Thirty-eight patients (41%) were classified as ERs, 20 (22%) as LRs, and 35 (38%) as NRs. On a multivariate regression analysis, the P group [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.08-10.45; p=0.036] and NR (OR, 4.04; 95% CI, 1.29-14.27; p=0.016) were independent predictors of a poor outcome. ER (47%, p=0.01) and LR (45%, p=0.01) patients showed fewer poor outcomes than NR (77%) patients, but the rate did not differ significantly between the ER and LR patients. CONCLUSION Early mild clinical recovery did not predict a good outcome. The occlusion site was a stronger predictor of clinical improvement after IVtPA administration.
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Affiliation(s)
- Kentaro Suzuki
- Department of Neurological Science, Nippon Medical School, Japan
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145
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Ji R, Du W, Shen H, Pan Y, Wang P, Liu G, Wang Y, Li H, Zhao X, Wang Y. Web-based tool for dynamic functional outcome after acute ischemic stroke and comparison with existing models. BMC Neurol 2014; 14:214. [PMID: 25927216 PMCID: PMC4255632 DOI: 10.1186/s12883-014-0214-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is one of the leading causes of death and adult disability worldwide. In the present study, we aimed to develop a web-based risk model for predicting dynamic functional status at discharge, 3-month, 6-month, and 1-year after acute ischemic stroke (Dynamic Functional Status after Acute Ischemic Stroke, DFS-AIS). METHODS The DFS-AIS was developed based on the China National Stroke Registry (CNSR), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Good functional outcome was defined as modified Rankin Scale (mRS) score ≤ 2 at discharge, 3-month, 6-month, and 1-year after AIS, respectively. Independent predictors of each outcome measure were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and plot of observed and predicted risk were used to assess model discrimination and calibration. RESULTS A total of 12,026 patients were included and the median age was 67 (interquartile range: 57-75). The proportion of patients with good functional outcome at discharge, 3-month, 6-month, and 1-year after AIS was 67.9%, 66.5%, 66.9% and 66.9%, respectively. Age, gender, medical history of diabetes mellitus, stroke or transient ischemic attack, current smoking and atrial fibrillation, pre-stroke dependence, pre-stroke statins using, admission National Institutes of Health Stroke Scale score, admission blood glucose were identified as independent predictors of functional outcome at different time points after AIS. The DFS-AIS was developed from sets of predictors of mRS ≤ 2 at different time points following AIS. The DFS-AIS demonstrated good discrimination in the derivation and validation cohorts (AUROC range: 0.837-0.845). Plots of observed versus predicted likelihood showed excellent calibration in the derivation and validation cohorts (all r = 0.99, P < 0.001). When compared to 8 existing models, the DFS-AIS showed significantly better discrimination for good functional outcome and mortality at discharge, 3-month, 6-month, and 1-year after AIS (all P < 0.0001). CONCLUSION The DFS-AIS is a valid risk model to predict functional outcome at discharge, 3-month, 6-month, and 1-year after AIS.
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Affiliation(s)
- Ruijun Ji
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Wanliang Du
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Haipeng Shen
- Department of Statistics and Operation Research, University of North Carolina, Chapel Hill, NC, USA.
| | - Yuesong Pan
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Penglian Wang
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Gaifen Liu
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Yilong Wang
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Hao Li
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Xingquan Zhao
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Yongjun Wang
- Tiantan Comprehensive Stroke Center, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Beijing, 100050, Dongcheng District, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
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146
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Bray BD, Campbell J, Cloud GC, Hoffman A, James M, Tyrrell PJ, Wolfe CD, Rudd AG. Derivation and External Validation of a Case Mix Model for the Standardized Reporting of 30-Day Stroke Mortality Rates. Stroke 2014; 45:3374-80. [DOI: 10.1161/strokeaha.114.006451] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Case mix adjustment is required to allow valid comparison of outcomes across care providers. However, there is a lack of externally validated models suitable for use in unselected stroke admissions. We therefore aimed to develop and externally validate prediction models to enable comparison of 30-day post-stroke mortality outcomes using routine clinical data.
Methods—
Models were derived (n=9000 patients) and internally validated (n=18 169 patients) using data from the Sentinel Stroke National Audit Program, the national register of acute stroke in England and Wales. External validation (n=1470 patients) was performed in the South London Stroke Register, a population-based longitudinal study. Models were fitted using general estimating equations. Discrimination and calibration were assessed using receiver operating characteristic curve analysis and correlation plots.
Results—
Two final models were derived. Model A included age (<60, 60–69, 70–79, 80–89, and ≥90 years), National Institutes of Health Stroke Severity Score (NIHSS) on admission, presence of atrial fibrillation on admission, and stroke type (ischemic versus primary intracerebral hemorrhage). Model B was similar but included only the consciousness component of the NIHSS in place of the full NIHSS. Both models showed excellent discrimination and calibration in internal and external validation. The c-statistics in external validation were 0.87 (95% confidence interval, 0.84–0.89) and 0.86 (95% confidence interval, 0.83–0.89) for models A and B, respectively.
Conclusions—
We have derived and externally validated 2 models to predict mortality in unselected patients with acute stroke using commonly collected clinical variables. In settings where the ability to record the full NIHSS on admission is limited, the level of consciousness component of the NIHSS provides a good approximation of the full NIHSS for mortality prediction.
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Affiliation(s)
- Benjamin D. Bray
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - James Campbell
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - Geoffrey C. Cloud
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - Alex Hoffman
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - Martin James
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - Pippa J. Tyrrell
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - Charles D.A. Wolfe
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
| | - Anthony G. Rudd
- From the Division of Health and Social Care Research, King’s College London, London, United Kingdom (B.D.B., C.D.A.W., A.G.R.); Clinical Effectiveness Unit, Royal College of Physicians, London, United Kingdom (J.C., A.H.); Stroke Unit, St George’s NHS Trust, London, United Kingdom (G.C.C.); Stroke Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom (M.J.); Stroke Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom (P.J.T.); and National Institute for Health
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Smith EE, Saver JL, Alexander DN, Furie KL, Hopkins LN, Katzan IL, Mackey JS, Miller EL, Schwamm LH, Williams LS. Clinical Performance Measures for Adults Hospitalized With Acute Ischemic Stroke. Stroke 2014; 45:3472-98. [DOI: 10.1161/str.0000000000000045] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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148
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Racosta JM, Di Guglielmo F, Klein FR, Riccio PM, Giacomelli FM, González Toledo ME, Pagani Cassará F, Tamargo A, Delfitto M, Sposato LA. Stroke Severity Score based on Six Signs and Symptoms The 6S Score: A Simple Tool for Assessing Stroke Severity and In-hospital Mortality. J Stroke 2014; 16:178-83. [PMID: 25328876 PMCID: PMC4200591 DOI: 10.5853/jos.2014.16.3.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose Ascertaining stroke severity and predicting risk of in-hospital mortality is crucial to advise patients and families about medical decisions. We developed and tested the validity of a new stroke score, the 6S Score (Stroke Severity Score based on Six Signs and Symptoms), for quantifying ischemic stroke severity and predicting in-hospital mortality. Methods We prospectively assessed 210 consecutive acute ischemic stroke patients. The cohort was further divided into a derivation (n=120) and a validation (n=90) sample. From a total of 10 stroke signs and symptoms, we selected those with likelihood ratio's P<0.005. We tested the validity of the score for predicting in-hospital mortality by using receiver operating characteristic curves. We used a scatterplot and the Spearman's test to evaluate the correlation between the 6S Score and the National Institutes of Health Stroke Scale as a marker of stroke severity. We used principal component and exploratory factor analyses for assessing qualitative aspects of the 6S Score. Results The C statistic for in-hospital mortality was 0.82 for the 6S Score and 0.86 for the National Institutes of health Stroke Scale, respectively, with no significant differences between each other (P=0.79). The correlation between both scores was strong (Spearman's rho 0.68, P<0.001). The factor analyses showed a good balance between left/right hemispheres and anterior/posterior circulations. Conclusions The 6S Score may constitute a tool for easily assessing stroke severity and predicting stroke mortality. Further research is needed for further assessing its external validity.
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Affiliation(s)
- Juan Manual Racosta
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Federico Di Guglielmo
- Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina
| | - Francisco Ricardo Klein
- Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina
| | - Patricia Mariana Riccio
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | | | | | - Fátima Pagani Cassará
- Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina
| | - Agustina Tamargo
- Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina
| | - Matías Delfitto
- Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina
| | - Luciano Alberto Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
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149
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Poor Performance of Stroke Prognostication Using Age and National Institutes of Health Stroke Scale-100 to Predict 3- and 12-month Outcomes of Ischemic Stroke in China National Stroke Registry. J Stroke Cerebrovasc Dis 2014; 23:2335-40. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/22/2014] [Indexed: 11/21/2022] Open
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150
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Cardiac diastolic dysfunction predicts in-hospital mortality in acute ischemic stroke with atrial fibrillation. J Neurol Sci 2014; 345:83-6. [DOI: 10.1016/j.jns.2014.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 11/22/2022]
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