Lessons from everyday stroke care for clinical research and vice versa: comparison of a comprehensive and a research population of young stroke patients

Abstract

BackgroundTranslating knowledge derived from medical research into the clinical setting is dependent on the representativeness of included patients. Therefore we compared baseline data of patients included in a recent large study addressing young stroke in comparison to a large representative stroke registry.MethodsWe analysed baseline data of 5023 patients (age 18-55 years) with an acute cerebrovascular event included in the sifap1 (Stroke in Young Fabry Patients) study. For comparison 17007 stroke patients (age 18-55 years) documented (2004-2010) in a statutory stroke registry of the Institute of Quality Assurance Hesse of the Federal State of Hesse (GQH), Germany.ResultsAmong 17007 juvenile (18-55 years) patients identified in the GQH registry 15997 had an ischaemic stroke or TIA (91%) or an intracranial haemorrhage (9%). In sifap1 5023 subjects were included. Sex distribution was comparable (men: 59% sifap1 versus 60.5% GQH) whereas age differed between the groups: median age was 46 years in sifap1 versus 49 years in GQH. Slightly higher percentages for diabetes mellitus and hypertension in the GQH registry were noted. There were no differences in stroke severity as assessed by NIHSS (median 3) and mRS (median 2). In patients with ischaemic stroke or TIA (n = 4467 sifap1; n = 14522 GQH) higher rates of strokes due to small artery occlusion and atherosclerosis occurred in older age groups; cardioembolism and strokes of other determined cause occurred more frequently in younger patients.ConclusionsThe comparison of baseline characteristics between the sifap1 study and the GQH registry revealed differences mainly determined by age.

Brain Magnetic Resonance Imaging Findings Fail to Suspect Fabry Disease in Young Patients With an Acute Cerebrovascular Event

“…For the latter aspect, we have collected evidence that the group of patients included in SIFAP 1 was representative of young patients admitted to participating centers 12 and of young patients with stroke overall when compared with a regional stroke registry. 20 About selection for present study, which was driven primarily by availability and quality of MRI, it is likely that we have excluded more patients from centers with limited access to MRI and who were severely affected by their CVE. However, it is unlikely that this would have influenced our findings in a systematic manner.…”

Comprehensive Geriatric Care in Older Adults: Walking Ability after an Acute Fracture

“…However, there is a lack of investigations aimed at demonstrating the benefits of CGC in a routine care environment. Conditions in the routine clinical settings in which caregivers work are different from the strict pre-specified workflows and rigorous selection of patients that prevail in clinical trials [ 28 , 29 ]. The positive effects of CGC, therefore, require verification by means of large-scale investigations [ 30 , 31 , 32 ].…”

Frequency and predictors of acute ischaemic lesions on brain magnetic resonance imaging in young patients with a clinical diagnosis of transient ischaemic attack

“…Recent studies on young stroke patients provided detailed information on age and gender distribution, risk factors, aetiological factors and imaging findings . They emphasized the limitation in translating knowledge from general stroke populations to the specific subgroup of younger stroke patients . Therefore, the frequency of and clinical parameters associated with the detection of DWI lesions in young TIA patients included in the ‘Stroke in Young Fabry Patients’ (sifap1) study, a large multicentre European study on young stroke, were investigated .…”