Dichotomous “Good Outcome” Indicates Mobility More Than Cognitive or Social Quality of Life

Naidech, Andrew M.; Beaumont, Jennifer L.; Berman, Michael D.; Francis, Brandon; Liotta, Eric M.; Maas, Matthew B.; Holl, Jane L.; Cella, David

doi:10.1097/ccm.0000000000001082

Cited by 27 publications

(28 citation statements)

References 23 publications

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“…Recent small studies have shown that they correlate well with the mRS but have greater capacity to discriminate smaller but still meaningful change. 23,24 In order to address the issue of futility, future research efforts should use pooled analysis of data from recent trials as well as large imaging based observational studies that enroll either patients without the TRAITs or all comers with a subsequent analysis of outcome by imaging profile to derive futility thresholds for current reperfusion therapy. 25 …”

Section: Opportunities For Standardizationmentioning

confidence: 99%

Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials

Warach

Luby

Albers

et al. 2016

Stroke

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Background and Purpose The STroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neuroradiology and the Foundation of the American Society of Neuroradiology sponsored an imaging session and workshop during the Stroke Treatment Academy Industry Roundtable (STAIR) IX on October 5–6, 2015 in Washington, D.C. The purpose of this roadmap was to focus on the role of imaging in future research and clinical trials. Methods This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), industry representatives, and members of the U.S. Food and Drug Administration (FDA) to discuss stroke imaging research priorities in the light of an unprecedented series of positive acute stroke endovascular therapy clinical trials. Results The imaging session summarized and compared the imaging components of the recent positive endovascular trials, and proposed opportunities for pooled analyses. The imaging workshop developed consensus recommendations for optimal imaging methods for the acquisition and analysis of core, mismatch and collaterals across multiple modalities, and also a standardized approach for measuring the final infarct volume in prospective clinical trials. Conclusions Recent positive acute stroke endovascular clinical trials have demonstrated the added value of neurovascular imaging. The optimal imaging profile for endovascular treatment includes large vessel occlusion, smaller core, good collaterals and large penumbra. However, equivalent definitions for the imaging profile parameters across modalities are needed, and a standardization effort is warranted, potentially leveraging the pooled data resulting from the recent positive endovascular trials.

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Section: Opportunities For Standardizationmentioning

confidence: 99%

Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials

Warach

Luby

Albers

et al. 2016

Stroke

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“…While we found that all patients who had delirium with agitation had some level ofmotor disability, HRQoL provides additional insights to outcomes that might be missed by a summary scale. (34)…”

Section: Resultsmentioning

confidence: 99%

Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage

et al. 2017

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Introduction Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium, and found worse outcomes in Health Related Quality of Life (HRQoL) in the domain of Cognitive Function. We tested the hypothesis that agitation would have additional prognostic significance on later Cognitive Function HRQoL. Materials and Method Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, three months, and one year. Functional outcomes were measured with the modified Rankin Scale. Results Among the 81 patients with health related quality of life follow up data available, patients who had agitation and delirium had worse Cognitive Function HRQoL scores at 28 days (T-scores for delirium with agitation 20.9 ± 7.3, delirium without agitation 30.4 ± 16.5, agitation without delirium 36.6 ± 17.5, neither agitated nor delirious 40.3 ± 15.9, P=0.03), and at 1 year (P=0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (P=0.0006), and was not associated with medication use, seizures or infection. Conclusions The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to one year later.

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“…Adverse events associated with phenytoin are relatively easy to detect. 4 Levetiracetam has fewer side effects than phenytoin, and any adverse effects on cognition or behavior are likely to be detected only in patients already considered to have a “good outcome.” 13 Other validated scores of health-related quality of life and cognition could be a useful adjunct. 14, 15 …”

Section: Discussionmentioning

confidence: 99%