Improving the Assessment of Outcomes in Stroke

Wilson, Lindsay; Hareendran, Asha; Grant, Marie; Baird, Tracey; Schulz, Ursula G.; Muir, Keith W.; Bone, Ian

doi:10.1161/01.str.0000027437.22450.bd

Cited by 672 publications

(288 citation statements)

References 17 publications

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“…SICH was defined as a neurological deterioration (NIHSS increment ≥ 4 points) within 48 h following trombolysis with an intraparenchymal hematoma demonstrated by brain CT scan. The modified Rankin Scale (mRS) score at 3 months was assessed with a structured interview [11] by a trained stroke nurse. The mRS was dichotomized into 0-2 (favorable outcome) and 3-6 (unfavorable outcome).…”

Section: Outcome Measuresmentioning

confidence: 99%

Safety of routine IV thrombolysis between 3 and 4.5 h after ischemic stroke

Uyttenboogaart

Vroomen

Stewart

et al. 2007

Journal of the Neurological Sciences

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Background: The administration of tissue plasminogen activator (t-PA) has been proven effective for ischemic stroke within 3 h after onset. A pooled-analysis of six trials showed that intravenous t-PA still improves outcome when given between 3 to 4.5 h after stroke onset. On the basis of this pooled analysis, t-PA was also routinely offered to our patients between 3-4.5 h. We report the safety and clinical features of this group together with the features of the group given t-PA within 3 h. Methods: Prospectively patient characteristics, stroke severity, stroke subtype, incidence of symptomatic intracerebral hemorrhage (SICH), in-hospital mortality, and 3-months modified Rankin Scale scores (mRS) were registered. Data was analyzed separately for patients treated within 3 h (early group) and those treated between 3-4.5 h (late group). Results: Among 176 patients who underwent intravenous thrombolysis, 101 were treated in the early group and 75 in the late group. Six (5.9%; 95% CI 2.8%-12.3%) patients in the early group and 4 (5.3%; 95% CI 2.2%-12.9%) in the late group developed SICH (p = 1.0). In the early group 13 (12.9%; 95% CI 7.7%-20.8%) patients died within 7 days after admission, compared to 5 (6.7%; 95% CI 3.0%-14.7%) in the late group (p = 0.179). In the early group 44 (43.6%; 95% CI 43.3%-53.3%) were independent (mRS ≤ 2) at three months, compared to 36 (48.0%; 95% CI 37.0%-59.1%) in the late group (p = 0.559). Conclusion: Our data show no trend of decreased safety of thrombolysis beyond 3 h. Due to a small sample size a harmful effect cannot be excluded but seems unlikely.

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Section: Outcome Measuresmentioning

confidence: 99%

Safety of routine IV thrombolysis between 3 and 4.5 h after ischemic stroke

Uyttenboogaart

Vroomen

Stewart

et al. 2007

Journal of the Neurological Sciences

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“…The GOS is a five-point ordinal functional outcome scale that has been used in many prior clinical studies of TBI; a score of 5 represents good recovery and a score of 1 represents death. [14][15][16] Because of small numbers of subjects in some groups and for purposes of analysis and presentation, the GOS was collapsed into three outcome points by combining ''good'' and ''moderate'' and combining ''vegetative'' and ''dead'' into single values on the scale. SBI Dose.…”

mentioning

confidence: 99%

A Novel Method of Evaluating the Impact of Secondary Brain Insults on Functional Outcomes in Traumatic Brain-injured Patients

et al. 2005

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Objectives: Prior studies suggest that the emergency department (ED) occurrence of secondary brain insults (SBIs), such as systemic hypotension and hypoxia, worsens outcome in patients with traumatic brain injury. However, previous methods of assessing SBIs have been relatively crude, generally only determining the incidence and duration of events. The authors hypothesized that a new method that accounts for the cumulative depth and duration of SBIs would provide a more informative measure that better correlates with outcome. Methods: The authors developed a computer algorithm to calculate the total ''dose'' of an SBI (in this case, hypotension and hypoxia) as the area under the curve between a cut-point value and a measured vital sign over time. To test this method, the authors used an existing data set of head trauma patients for whom occurrence in the ED of any hypotension had been shown to be associated with in-hospital mortality. The authors applied the algorithm using the cut-point values from the prior study (systolic blood pressure #90 mm Hg and oxygen saturation #92%). The effects of SBIs on inhospital mortality and three-month Glasgow Outcome Scale score were evaluated. Results: Of 107 patients overall, 26 had hypotension (dose range 0.2-898 mm Hg Á min) and 40 had hypoxia (dose range 0.005-6.7% Á min). Moderate and high doses of hypotension were more strongly associated with outcome than the measures from the initial study (any hypotension and number of hypotensive episodes). Hypoxia had no effect. Conclusions: New methods of measuring SBIs that take into account depth and duration of episodes may more accurately reflect the influence of these events on outcome after head trauma.

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“…This was done through the evaluation of 30 adult patients with clinical and/or molecular confirmation of HSP in two stages, by 2 experienced researchers, and using coefficients of correlations and variability. For each patient, we also applied the Rankin scale 11 . This was done to investigate whether SPRS-BR scores correlate with this measure of independence for activities of daily living.…”

Section: Translation Of Sprs and Cultural Adaptationmentioning

confidence: 99%

Translation and validation into Brazilian Portuguese of the Spastic Paraplegia Rating Scale (SPRS)

Servelhere

Faber

Coan

et al. 2016

Arq. Neuro-Psiquiatr.

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Hereditary spastic paraplegias (HSP) are characterized by progressive lower limb weakness and spasticity. There are no validated instruments to quantify disease severity in Portuguese. Objective To translate and validate the Spastic Paraplegia Rating Scale (SPRS) into Brazilian-Portuguese. Method Two experienced and English-fluent neurologists translated SPRS into Portuguese, creating SPRS-BR. We then assessed inter and intra-rater reliability of this version using coefficients of correlation and variability in a cohort of 30 patients. Results Mean age of patients and disease duration were 47.7 ± 10.5 and 17.0 ± 10.6 years, respectively. Twenty-one had pure HSP and SPG4 was the most frequent genotype. Mean Rankin and SPRS-BR scores were 2.2 ± 0.9 and 19.9 ± 9.9, respectively. Mean intra and inter-rater correlation coefficients of SPRS-BR scores were 0.951 and 0.934, whereas coefficients of variation were 11.5% (inter-rater) and 9.9% (intra-rater). Cronbach’s alpha for the whole SPRS-BR scale was 0.873. Conclusion SPRS-BR is a useful, reliable and valid clinical instrument.

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Improving the Assessment of Outcomes in Stroke

Cited by 672 publications

References 17 publications

Safety of routine IV thrombolysis between 3 and 4.5 h after ischemic stroke

Safety of routine IV thrombolysis between 3 and 4.5 h after ischemic stroke

A Novel Method of Evaluating the Impact of Secondary Brain Insults on Functional Outcomes in Traumatic Brain-injured Patients

Translation and validation into Brazilian Portuguese of the Spastic Paraplegia Rating Scale (SPRS)

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