Predicting the outcome of acute stroke: prospective evaluation of five multivariate models and comparison with simple methods.

Gladman, John; Harwood, Diana; Barer, David

doi:10.1136/jnnp.55.5.347

Cited by 89 publications

(42 citation statements)

References 13 publications

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“…Their mean BI was 3.6 (0-13) and increased to 6.3 (0-19) at T2 (6 weeks). Eight patients had a delayed MEP with clinical improvement on BI from 5.5 (1-12) to 14.6 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The BI of the other 10 patients who had a normal motor response, increased from 4.9 (0-10) at T1 to 15.5 (4-20) at T2 (Fig.…”

Section: Magnetic Evoked Potentialsmentioning

confidence: 99%

“…This can be of importance with regard to clinical and rehabilitative programs and information to patients and clinicians. In the past, some studies demonstrated that clinical parameters, such as deviated conjugate eye gaze, urinary incontinence, impaired consciousness, and leg weakness have some predictive value in stroke [1][2][3]. Although a quantified scaled neurologic examination might give some progne~stic information, one cannot make reliable predictions about functional outcome in individual patients [4].…”

Section: Introductionmentioning

confidence: 99%

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The prognostic value of cortical magnetic stimulation in acute middle cerebral artery infarction compared to other parameters

Timmerhuis

Hageman

Oosterloo

et al. 1996

Clinical Neurology and Neurosurgery

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The prognostic value of :magnetic evoked potentials (MEP), somatosensory evoked potentials (SSEP), age and radiological parameters was determined in 50 patients with acute middle cerebral artery infarction. We performed MEP and SSEP within 4 days and after 6 weeks and 3 months of the infarction and assessed clinical improvement by using the Barthel index (BI) and the Rankin scale. The localization and extent of the infarction was investigated by CT scanning or NMR. All parameters were correlated to clinical outcome and the prognostic significance of each parameter in addition to BI was determined. MEP, SSEP, and age were valuable prognostic parame~Lers in predicting stroke outcome when used together with the BI. However, in stepwise regression analysis using all parameter:s simultaneously, only MEP and age significantly contributed to clinical outcome in addition to BI. Patients showed a better outcome when their MEP was normal or delayed, measured within 4 days of the infarction, compared to patients with absent MEP. Clinical outcome was better at a younger age.

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Section: Magnetic Evoked Potentialsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The prognostic value of cortical magnetic stimulation in acute middle cerebral artery infarction compared to other parameters

Timmerhuis

Hageman

Oosterloo

et al. 1996

Clinical Neurology and Neurosurgery

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“…26,27 Therefore, it is prudent to exclude patients with mental status changes or severe hemiparesis from surgical intervention. 11,14,16,19 That severity of neurologic deficit as classified by the modified Rankin score did not significantly influence outcome in our series (Table 6), does not refute this experience but underscores the importance of patient selection, excluding from immediate surgery patients with severely debilitating deficits.…”

Section: Discussionmentioning

confidence: 99%

Early Carotid Surgery for Recent Neurologic Deficit

Schunn¹,

Hetzel²,

Lange³

et al. 2000

Perspectives in Vascular Surgery

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Early carotid endarterectomy after recent neurologic deficit is controversial. Traditionally, an interval of at least 4 to 6 weeks has been recommended based on poor historical results of early surgical intervention after recent strokes and fear of hemorrhagic transformation of the infarct. On the other hand, recurrent strokes have been observed in up to 9.5% of patients while awaiting carotid repair. Since 1996 we have adopted a more aggressive approach to a highly selected group of patients with fresh ischemic deficits, prolonged reversible ischemic neurologic deficit (PRIND), or crescendo transient ischemic attacks (TIAs). Of 2824 patients who underwent carotid endarterectomy between August 1996 and December 1998, 112 patients (3.9%) underwent 123 carotid operations within less than 30 days (median interval: 8 days) after a nondisabling stroke, PRIND, or TIA. Postoperatively five patients (4.4%) suffered a stroke, one patient a transient worsening of his preoperative deficit, and one patient a TIA. Six patients died, three of which were due to their stroke (mortality 5.3%). One of these fatal strokes was due to an intracerebral hemorrhage in a patient with normal preoperative computed tomography. The combined 30-day permanent neurologic stroke and death rate was 7.1%. Functional neurologic outcome was excellent with 74.1% of patients suffering no or minimal deficit (Rankin scale 0-1). Patients with unstable or progressing neurologic deficit were found to have a significantly increased postoperative stroke rate (25%). Early carotid endarterectomy after nondisabling neurologic deficit may be performed with acceptable risk in carefully selected patients. The benefit of early versus delayed surgery, however, can only be determined in a prospective randomized study. 95

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“…However, the number of significant explanatory variables incorporated into one prediction formula was only 4.1 on average [4]. Furthermore, the Japanese Guidelines for the Management of Stroke 2015 [5] says that "even if the variables used for prediction are simply increased, the prediction accuracy does not necessarily rise [6,7], and the advantages of using the simplest prediction method are also shown [8]". On the other hand, it has also been reported that by adding comorbidities to explanatory variables, the coefficient of determination R 2 of multiple regression analysis with FIM at discharge as the objective variable rose from 0.732 to 0.798 [9] and R 2 rose from 0.61 to 0.64 by adding Stroke Impairment Assessment Set (SIAS) [10].…”

Section: Using Appropriate Explanatory Variablesmentioning

confidence: 99%

Methods for Improving the Predictive Accuracy Using Multiple Linear Regression Analysis to Predict the Improvement Degree of Functional Independence Measure for Stroke Patients

Tokunaga¹,

Hashimoto²,

Watanabe³

et al. 2017

Int J Phys Med Rehabil

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Multiple linear regression analysis is frequently used in studies investigating the degree of Functional Independence Measure (FIM) improvement in stroke patients. However, the coefficient of determination R 2 is about 0.46 to 0.73, meaning that the prediction accuracy is not necessarily high. In order to improve the prediction accuracy, the following methods are used; using appropriate explanatory variables, using FIM effectiveness which corrected the ceiling effect as the objective variable, creating multiple prediction formulas, converting numerical variable of explanatory variables into dummy variable, adding FIM improvement for one month to the explanatory variables. Even so, it is difficult to predict patients whose FIM gain is extremely large or small. It is desirable to combine these methods or develop new methods to achieve the accurate prediction.

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Predicting the outcome of acute stroke: prospective evaluation of five multivariate models and comparison with simple methods.

Cited by 89 publications

References 13 publications

The prognostic value of cortical magnetic stimulation in acute middle cerebral artery infarction compared to other parameters

The prognostic value of cortical magnetic stimulation in acute middle cerebral artery infarction compared to other parameters

Early Carotid Surgery for Recent Neurologic Deficit

Methods for Improving the Predictive Accuracy Using Multiple Linear Regression Analysis to Predict the Improvement Degree of Functional Independence Measure for Stroke Patients

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