The JAGUAR Score Predicts 1-Month Disability/Death in Ischemic Stroke Patient Ineligible for Recanalization Therapy

Seasonal Variation in Incidence of Stroke in a General Population of 1.4 Million Japanese: The Shiga Stroke Registry

INTRODUCTION

The purpose of this study was to investigate seasonal variation in stroke incidence using data from a large-scale stroke registry of general population in current Japan.

METHODS

Shiga Stroke Registry (SSR) is an ongoing population-based registry of stroke that occurred in the Shiga Prefecture in central Honshu, Japan. A total 6,688 cases of first-ever stroke, with onset dates ranging from 1 January 2011 to 31 December in 2013 were included in this study. Incidence rates of first-ever stroke in each season were estimated using the person-year approach and adjusted for age and sex using the Poisson regression models.

RESULTS

From 2011 to 2013, we identified a total of 6,688 stroke cases (3,570 men, 3,118 women), of which 4,480 cases had ischemic stroke (2,518 men, 1,962 women), 1,588 had intracerebral hemorrhage (857 men, 731 women) and 563 had subarachnoid hemorrhage (166 men, 397 women). Age- and sex-adjusted incidence rates of total stroke were 151 (95% confidence interval [CI] 144-160, p = <0.001 vs. summer) in spring, 130 (95% CI 122-137) in summer, 141 (95% CI 133-149, p = 0.020 vs. summer) in autumn and 170 (95% CI 161-179, p = <0.001 vs. summer) in winter. Seasonal variation was more pronounced in intracerebral hemorrhage than in ischemic stroke.

CONCLUSION

In the present large-scale stroke registry of general population, incidence rates of stroke were highest in winter and lowest in summer in current Japan.

Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies

Background, Objective: At least 70% of all stroke patients are ineligible for recanalization therapy. We identified predictors of outcome among these patients, with special focus on notification of emergency medical services (EMS).

Methods: We prospectively collected data of 250 consecutive patients with acute cerebrovascular diseases ineligible for recanalization therapy. Initial notification strategy and outcome were analyzed by regression models.

Results: EMS notification rate was 55, 41, and 21% in patients with <6, 6–24, and >24 h stroke-to-door time. Atrial fibrillation (AF; OR = 2.66, 95% CI: 1.19–5.96), stroke severity (National Institutes of Health Stroke Scale score, NIHSS; OR = 1.12, 95% CI: 1.02–1.23), history of any psychiatric disease (OR = 2.2, 95% CI: 0.98–4.97), aphasia (OR = 1.99, 95% CI: 0.99–3.98), and residence type were predictors of EMS notification. Disability (modified Rankin Scale score [mRS]) both at discharge and at 1 year was associated with age, admission NIHSS score, type of cerebrovascular disorder, and pre-stroke mRS at discharge and discharge mRS at follow-up. Age (HR = 1.05, 95% CI: 1.02–1.08) and NIHSS (HR = 1.16, 95% CI: 1.12–1.21) had a significant effect on the relative hazard of death.

Conclusions: EMS notification is influenced by AF, stroke severity, psychiatric disease, aphasia, and residence type. Early disability depends on age, the type and severity of the stroke, and pre-stroke mRS. Predictors of disability at 1 year after stroke are age, stoke severity, mRS at discharge, and recurrent ischemic stroke. Higher NIHSS and older age are associated with higher case fatality. In patients ineligible for recanalization, EMS notification had no significant effect on outcome, regarding both disability and survival.