Categorizing Stroke Prognosis Using Different Stroke Scales

Govan, Lindsay; Langhorne, Peter; Weir, Christopher J.

doi:10.1161/strokeaha.109.557645

Cited by 119 publications

(96 citation statements)

References 10 publications

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“…There is excellent agreement between the mRS and Barthel Index scores for discrimination of the functional severity of stroke (weighted 0.85). 29 Analysis of our own data 11 shows that GOS score 1-3 has excellent agreement with mRS 4 -6 ( 0.87). Because there is evidence that age and previous disability may confound the relationship between pre-ICH APT and outcome, 4 we requested that authors contributing multivariate analyses adjusted for both age and premorbid disability, typically defined as mRS Ͼ1, if such data were available.…”

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confidence: 87%

Prior antiplatelet therapy and outcome following intracerebral hemorrhage

Béjot²,

et al. 2010

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Objectives: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and metaanalysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH. Methods:The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with Ͼ100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model. Results:We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29). Conclusions:In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome. Neurology GLOSSARYAPT ϭ antiplatelet therapy; CI ϭ confidence interval; GOS ϭ Glasgow Outcome Scale; ICH ϭ intracerebral hemorrhage; mRS ϭ modified Rankin Scale; OR ϭ odds ratio.Aspirin or other antiplatelet therapy (APT) could worsen outcome from intracerebral hemorrhage (ICH) by promoting bleeding. Published observational studies of outcomes in pre-ICH APT users have yielded conflicting results, however. Some suggest an increased risk of poor outcome 1-3 while others suggest no increased risk. 4,5 If prior APT worsens outcome, then restoration of normal platelet function could be a therapeutic target.We hypothesized that pre-ICH APT use would be associated with increased mortality and functional impairment following ICH, and tested this hypothesis by performing a systematic review of the literature. To reduce the likelihood of publication bias, we additionally requested information from established cohort studies that had not previously published on the association between pre-ICH APT and clinical outcomes.METHODS Search strategy, selection criteria, and data abstraction. Using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria as a guide, 6 we searched for studies describing mortality or functional outcome of consecutive adults with spontaneous ICH by APT use, ex...

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confidence: 87%

Prior antiplatelet therapy and outcome following intracerebral hemorrhage

Béjot²,

et al. 2010

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“…4,9 -11 Finally, the BI has demonstrated excellent discriminative properties in organized inpatient trials. 12 Moreover, a number of prospective studies have shown that the severity of disability according to the BI recorded at 5 days poststroke, even when dichotomized, 13 shows a highly prognostic accuracy for death 13 or dependency as a final outcome. 1,[13][14][15] As a consequence, the BI has been recommended to be used for the development of predictive risk models to estimate final outcome for those patients who were lost in trials.…”

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confidence: 99%

Diagnostic Accuracy of the Barthel Index for Measuring Activities of Daily Living Outcome After Ischemic Hemispheric Stroke

Kwakkel

Veerbeek

Wel

et al. 2011

Stroke

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on behalf of the Early Prediction of functional Outcome after Stroke (EPOS) InvestigatorsBackground and Purpose-This study investigated the diagnostic accuracy of the Barthel Index (BI) in 206 stroke patients, measured within 72 hours, for activities of daily living at 6 months and determined whether the timing of BI assessment during the first days affects the accuracy of predicting activities of daily living outcome at 6 months. Methods-Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cutoff points for BI at Days 2, 5, and 9. OR, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to predict BI Ն19. Results-The area under the curve ranged from 0.785 on Day 2 to 0.837 and 0.848 on Days 5 and 9. Comparison of the receiver operating characteristic curves showed that the area under the curve was significantly different between Days 2 and 5 (PϽ0.001) and between Days 2 and 9 (PϽ0.001). No significant difference was found between Days 5 and 9 (Pϭ0.08). Using a BI cutoff score of 7, the positive predictive value gradually increased from 0.696 on Day 2 to 0.817 on Day 2 to 0.864 on Day 9, whereas negative predictive value declined from 0.778 on Day 2 to 0.613 on Day 9. Conclusions-Assessment of the BI early poststroke showed good discriminative properties for final outcome of BI at 6 months. However, Day 5 proved to be the earliest time for making an optimal prediction of final outcome of activities of daily living. The BI should be measured at the end of the first week in hospital-based stroke units for early rehabilitation management. (Stroke. 2011;42:342-346.)

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“…Stroke severity was assessed using the Scandinavian Stroke Scale and categorized as very severe (0-14 points), severe (15-29 points), moderate (30-44 points), and mild (45-58 points). 16 From the Danish National Registry of Patients, to which all Danish nonpsychiatric hospitals must report every patient-hospital contact, we collected data concerning discharge diagnosis and comorbidity; the latter expressed using the Charlson Comorbidity Score Index, based on hospital contacts recorded within the last 10 years before admission. [17][18][19] …”

Section: Patient and Hospital Characteristicsmentioning

confidence: 99%

Off-Hours Admission and Acute Stroke Care Quality

Kristiansen¹,

Mainz

Nørgård³

et al. 2014

Stroke

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Background and Purpose— Studies have reported higher risks of death and other adverse outcomes in acute stroke patients admitted off-hours; however, little is known about the underlying mechanisms. According to time of admission, our aim was to examine compliance with performance measures for acute stroke care processes, including the effect of a systematic quality improvement program, and to examine 30 days case-fatality. Methods— A population-based historical cohort study, including patients admitted to Danish hospitals with a first ever acute stroke (January 1, 2003, to December 31, 2011; N=64 975). Off-hours were weekends and evening and nighttime shifts on weekdays. Compliance with performance measures was compared using general linear modeling, and odds ratios for 30 days case-fatality were obtained using multivariable logistic regression. Results— Patients admitted off-hours had a lower chance of compliance with 8 out of 10 performance measures; however, these differences diminished over time. Unadjusted odds ratio for 30 days case-fatality, for patients admitted off-hours compared with patients admitted on-hours, was 1.15 (95% confidence interval, 1.09–1.21). Adjusting for patient characteristics (in particular, stroke severity) decreased the odds ratio to 1.03 (95% confidence interval, 0.97–1.10). Additional adjustment for hospital characteristics and compliance with performance measures had no effect on the odds ratio. Conclusion— Patients admitted off-hours received a poorer quality of care. However, the admission time–related differences in care were substantially reduced over time, and the differences in 30 days case-fatality appeared primarily to be explained by differences in stroke severity.

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Categorizing Stroke Prognosis Using Different Stroke Scales

Cited by 119 publications

References 10 publications

Prior antiplatelet therapy and outcome following intracerebral hemorrhage

Prior antiplatelet therapy and outcome following intracerebral hemorrhage

Diagnostic Accuracy of the Barthel Index for Measuring Activities of Daily Living Outcome After Ischemic Hemispheric Stroke

Off-Hours Admission and Acute Stroke Care Quality

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