Abstract WP239: Ethnic Differences in Multiple Chronic Conditions Among Ischemic Stroke Patients From the Brain Attack Surveillance in Corpus Christi Project

Introduction: The risk of developing multiple chronic conditions (MCC) increases with age. MCC predicts stroke outcomes and impairs prestroke reserve that aids the neuropsychological process of stroke recovery. Mexican Americans (MAs) have increased stroke risk, worse stroke outcomes and a different profile of pre-stroke comorbidities compared to non-Hispanic whites (NHWs). We assessed ethnic differences in the overall burden of MCC among ischemic stroke patients from a bi-ethnic, population-based stroke study. Methods: We studied patients with ischemic stroke between November 2008 and March 2017. Twenty-two chronic conditions (prevalence 1%-83%) were identified from medical records and ICD-9 and 10 codes from hospital discharge data. MCC burden was measured by the total number of chronic conditions. Ethnic differences in terms of the odds of experiencing none (<2 conditions), low MCC (2-3 conditions), or high MCC (>4 conditions) were assessed using a proportional odds model adjusting for age (at stroke onset). Effect modification by age was also investigated. Results: Of 1,656 stroke patients, 68% were MA, 51% were female, mean age was 69 (SD=13), median number of MCC was 4 (IQR: 2-6). MAs were younger at stroke onset, but more likely to have higher age-adjusted MCC burden (OR 1.32, 95% CI: 1.07-1.62) compared to NHWs. The difference in MCC burden was modified by age (p= 0.02), with greater ethnic difference in MCC burden among younger patients (Figure). Conclusion: MAs have greater MCC burden at stroke onset compared to NHWs, especially in younger patients. The contribution of this ethnic difference in MCC burden to ethnic disparities in stroke outcome needs further investigation.

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Multiple Chronic Conditions Explain Ethnic Differences in Functional Outcome Among Patients With Ischemic Stroke

Stroke ◽

10.1161/strokeaha.120.032595 ◽

2021 ◽

Author(s):

Xiaqing Jiang ◽

Lewis B. Morgenstern ◽

Christine T. Cigolle ◽

Lu Wang ◽

Edward S. Claflin ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Chronic Conditions ◽

Ethnic Difference ◽

Effect Modification ◽

Multiple Chronic Conditions ◽

White People ◽

Discharge Data ◽

Stroke Outcomes ◽

Hispanic White

Background and Purpose: Mexican Americans (MAs) have worse stroke outcomes and a different profile of multiple chronic conditions (MCC) compared with non-Hispanic White people. MCC has implications for stroke treatment, complications, and poststroke care, which impact poststroke functional outcome (FO). We sought to assess the contribution of MCC to the ethnic difference in FO at 90 days between MAs and non-Hispanic White people. Methods: In a prospective cohort of ischemic stroke patients (2008–2016) from Nueces County, Texas, data were collected from patient interviews, medical records, and hospital discharge data. MCC was assessed using a stroke-specific and function-relevant index (range, 0–35; higher scores greater MCC burden). Poststroke FO was measured by an average score of 22 activities of daily living (ADLs) and instrumental ADLs at 90 days (range, 1–4; higher scores worse FO). The contribution of MCC to the ethnic difference in FO was assessed using Tobit regression. Effect modification by ethnicity was examined. Results: Among the 896 patients, 70% were MA and 51% were women. Mean age was 68±12.2 years; 33% of patients were dependent in ADL/instrumental ADLs (FO score >3, representing a lot of difficulty with ADL/instrumental ADLs) at 90 days. MAs had significantly higher age-adjusted MCC burden compared with non-Hispanic White people. Patients with high MCC score (at the 75th percentile) on average scored 0.70 points higher in the FO score (indicating worse FO) compared with those with low MCC score (at the 25th percentile) after adjusting for age, initial National Institutes of Health Stroke Scale, and sociodemographic factors. MCC explained 19% of the ethnic difference in FO, while effect modification by ethnicity was not statistically significant. Conclusions: MAs had a higher age-adjusted MCC burden, which partially explained the ethnic difference in FO. The prevention and treatment of MCC could potentially mitigate poststroke functional impairment and lessen ethnic disparities in stroke outcomes.

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Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Cerebrovascular Diseases ◽

10.1159/000445299 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 81-89 ◽

Cited By ~ 28

Author(s):

Mohamed Al-Khaled ◽

Christine Matthis ◽

Andreas Binder ◽

Jonas Mudter ◽

Joern Schattschneider ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Fatality ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Stroke Outcomes ◽

Increased Risk ◽

Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

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Abstract TP148: The Hydration Influence on the Risk of Ischemic Stroke Outcomes (THIRST-EXPANSION STUDY)

Stroke ◽

10.1161/str.44.suppl_1.atp148 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mohammad Moussavi ◽

Gustavo Rodriguez ◽

Joseph Alario ◽

Ravjot Sodhi ◽

Aaron Nizam ◽

...

Keyword(s):

Ischemic Stroke ◽

Negative Impact ◽

Serum Osmolality ◽

Hydration Status ◽

Stroke Severity ◽

Past Study ◽

Stroke Patients ◽

Stroke Outcomes ◽

Significant Difference ◽

The Mean

Introduction: Extensive studies have not been done in patients presenting with ischemic stroke regarding hydration status. It is unclear whether all of the elements of hydration status affect disability on discharge. Our past study suggests that high serum osmolality has a negative impact on ischemic stroke severity. This continuation of our prior study aims to test the effect of all laboratory elements of dehydration on severity and outcome of ischemic stroke patients. Methods: We conducted a retrospective analysis of ischemic stroke patients admitted between 2004 and 2009 at a community teaching hospital. Serum BUN/Creatinine and serum osmolality (sOsm) was calculated at initial presentation. sOSm, BUN/Cr, hematocrit and bicarbonate levels were analyzed for association with NIHSS and mRS. Patients were divided into two groups by sOsm as follows: (1) sOsm < 295, (2) sOsm ≥ 295; and two groups by BUN/Cr as follows: (3) BUN/Cr < 20, (4) BUN/Cr ≥ 20. Discharge mRS score was compared between (1) and (2); and (3) and (4) to determine the effect of sOsm and BUN/Cr on stroke outcomes. All data was analyzed using SPSS software version 20. Results: Of 1350 patients, 543 (mean age = 72.5 +/-14.2, 56% female) were included. There was a significant difference between the mean admission NIHSS in (1) 8.57, n = 222 and (2) 7.09, n = 319, p < .05 and between (3) 8.90, n = 219 and (4) 6.87, n = 322, p < .05. There was a significant difference in the mean mRS score between (1) 2.92, n = 222 and (2) 2.54, n = 317, p < .05, and (3) 2.92, n = 218 and (4) 2.56, n = 321, p < .05. The same results were found when comparing discharge sOsm values to predict patient outcome. Discharge sOsm correlated with mRS (r = .147, p < .05). Initial BUN/Cr correlated with NIHSS (r = .128, p < .05) and mRS (r = .107, p < .05) and final BUN/Cr with mRS (r = .161, p < .001). Bicarbonate levels at admission correlated with NIHSS at admission (r = -0.134), p < 0.05. Hematocrit levels at discharge correlated with mRS (r= -0.183), p <0.001. Conclusion: Our study suggests that patients with BUN/Cr and sOsm above normal levels at admission and dishcarge have worse outcome at discharge. We also found a correlation between other laboratory variables of dehydration status, namely hematocrit levels and outcome. A future prospective randomized study is warranted.

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Abstract TP418: Impact of Substance Use Disorder on Stroke Outcomes

Stroke ◽

10.1161/str.51.suppl_1.tp418 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Thomas Lawler ◽

Jessica Lee

Keyword(s):

Substance Use ◽

Ischemic Stroke ◽

Infective Endocarditis ◽

Control Group ◽

Stroke Patients ◽

Drug Induced ◽

Health Crisis ◽

Stroke Outcomes ◽

The Us ◽

Illicit Substances

Background: Substance abuse is a major health crisis in the US, with an estimated 20 million people suffering from substance use disorders (SUD). In addition to rising rates of SUD, Kentucky is located in the northern region of the stroke belt and has one of the highest rates of stroke hospitalizations in the US. Substance use may cause stroke by various mechanisms, including vasoconstriction, endothelial dysfunction, drug-induced vasculopathies, advanced rates of atherosclerosis, and infective endocarditis. We sought to examine the relationship between SUD and stroke outcomes. Methods: This is a single center, retrospective chart review of adults age >18 years with a diagnosis of ischemic or hemorrhagic stroke, and SUD based on either urine drug testing or medical record history, admitted between 12/6/2015 and 5/10/2019. We collected length of stay (LOS), admission/discharge NIHSS, discharge modified Rankin Scores, ICH scores, and discharge status and compared them to controls of ischemic stroke without SUD. Results: A total of 197 cases were identified [M=147 (74.6%)]. The most common illicit substances identified by testing were stimulants (42.6%, n=84), opioids (32.5%, n=64), and benzodiazepines (28.4%, n=56). Nearly all subjects had multiple substances present on screening. 13.8% (n=27) and 5.6% (n=11) received thrombolysis with either IV alteplase or mechanical thrombectomy, respectively. Compared to a control group of 176 ischemic stroke patients that did not test positive for illicit substances, cases (n= 139, ischemic stroke + SUD) were younger (mean=54.94+/-12.01 vs 66.15 +/- 14.38 yrs , p=0.0137), had a longer LOS (n=139, mean=8.44+/-10.84 vs 5.06 +/- 5.74, p=0.0006), higher admission NIHSS (mean=9.87+/-9.08, p=0.00012), and higher discharge NIHSS (mean=6.51+/-7.13 vs 4.19 +/- 5.73 , p=0.000512). Conclusion: Patients with SUD and stroke had longer LOS and worse discharge NIHSS compared to ischemic stroke patients without SUD. This could be due to the different mechanisms that cause strokes in substance users or could be a reflection of the effects of specific substances present at the time of admission. Future directions will include evaluating a hemorrhagic control population and examining a subpopulation of infective endocarditis.

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Abstract TP52: Endovascular Therapy in Patients Over 80 Years of Age With Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp52 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Janhavi M Modak ◽

Syed Daniyal Asad ◽

Jussie Lima ◽

Amre Nouh ◽

Ilene Staff ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Time Window ◽

Extended Time ◽

Stroke Patients ◽

Stroke Outcomes ◽

Stroke Treatment ◽

Group A ◽

Group B

Introduction: Acute ischemic stroke treatment has undergone a paradigm shift, with patients being treated in the extended time window (6-24 hours post symptom onset). The purpose of this study is to assess outcomes in stroke patients above 80 years of age undergoing endovascular treatment (EVT) in the extended time window. Methods: Acute ischemic stroke patients presenting to Hartford Hospital between January 2017 to June 2019 were considered for the study. Stroke outcomes in patients above 80 years of age with anterior circulation ischemic strokes presenting in the extended time window (Group A, n=30) were compared to a younger cohort of patients below 80 years (Group B, n=31). Patients over 80 years treated in the traditional time window (within 6 hours of symptom onset) served as a second set of controls (Group C, n=40). Statistical analysis was performed with a significance level of 0.05 Results: For angiographic results, there were no statistically significant differences in terms of good outcomes (TICI 2b-3) among patients of Group A, when compared to Groups B or C (p>0.05). For the endovascular procedures, no significant differences were noted in the total fluoroscopy time (Median Group A 44.05, Group B 38.1, Group C 35.25 min), total intra-procedure time (Median Group A 144, Group B 143, Group C 126 min) or total radiation exposure (Median Group A 8308, Group B 8960, Group C 8318 uGy-m 2 ). For stroke outcomes, a good clinical outcome was defined as modified Rankin score of 0-2 at discharge. Significantly better outcomes were noted in the younger patients in Group B - 35.4%, when compared to 13.3% in Group A (p=0.03). Comparative outcomes differed in the elderly patients above 80 years, Group A -13.3% vs Group C - 25%, although not statistically significant (p=0.23). There was a significant difference in mortality in patients of Group A - 40% as compared to 12% in the younger cohort, Group B (p= 0.01). Conclusions: In the extended time window, patients above 80 years of age were noted to have a higher mortality, morbidity compared to the younger cohort of patients. No significant differences were noted in the stroke outcomes in patients above 80 years of age when comparing the traditional and the extended time window for stroke treatment.

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Abstract TP215: Machine Learning Analysis of Gene Expression Data and Predictive Stroke Outcomes in Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp215 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sarah R Martha ◽

Qiang Cheng ◽

Liyu Gong ◽

Lisa Collier ◽

Stephanie Davis ◽

...

Keyword(s):

Gene Expression ◽

Machine Learning ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients ◽

Stroke Outcomes ◽

Inflammatory Genes ◽

Patient Demographics ◽

Edema Volume

Background and Purpose: The ability to predict ischemic stroke outcomes in the first day of admission could be vital for patient counseling, rehabilitation, and care planning. The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC; clinicaltrials.gov NCT03153683) collects blood samples distal and proximal to the intracranial thrombus during mechanical thrombectomy. These samples are a novel resource in evaluating acute gene expression changes at the time of ischemic stroke. The purpose of this study was to identify inflammatory genes and patient demographics that are predictive of stroke outcomes (infarct and/or edema volume) in acute ischemic stroke patients. Methods: The BACTRAC study is a non-probability, convenience sampling of subjects (≥ 18 year olds) treated with mechanical thrombectomy for emergent large vessel occlusion. We evaluated relative concentrations of mRNA for gene expression in 84 inflammatory molecules in static blood distal and proximal to the intracranial thrombus from adults who underwent thrombectomy. We employed a machine learning method, Random Forest, utilizing the first set of enrolled subjects, to predict which inflammatory genes and patient demographics were important features for infarct and edema volumes. Results: We analyzed the first 28 subjects (age = 66 ± 15.48, 11 males) in the BACTRAC registry. Results from machine learning analyses demonstrate that the genes CCR4, IFNA2, IL9, CXCL3, Age, DM, IL7, CCL4, BMI, IL5, CCR3, TNF, and IL27 predict infarct volume. The genes IFNA2, IL5, CCL11, IL17C, CCR4, IL9, IL7, CCR3, IL27, DM, and CSF2 predict edema volume. There is an intersection of genes CCR4, IFNA2, IL9, IL7, IL5, CCR3 to both infarct and edema volumes. Overall, these genes depicts a microenvironment for chemoattraction and proliferation of autoimmune cells, particularly Th2 cells and neutrophils. Conclusions: Machine learning algorithms can be employed to develop predictive biomarker signatures for stroke outcomes in ischemic stroke patients, particularly in regard to identifying acute gene expression changes that occur during stroke.

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Abstract TMP19: Intravenous Recombinant Tissue-type Plasminogen Activator Use in Young Adults With Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp19 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jodi A Dodds ◽

Ying Xian ◽

Shubin Sheng ◽

Gregg Fonarow ◽

Ronald A Matsouaka ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Older Patients ◽

Young Patients ◽

Tissue Type ◽

Stroke Patients ◽

Younger Patients ◽

Tissue Type Plasminogen Activator ◽

Type Plasminogen Activator

Background: Intravenous recombinant tissue-type plasminogen activator (rt-PA) administration improves outcomes in acute ischemic stroke. However, young patients (<40 years old) presenting with stroke symptoms may experience delays in treatment due to misdiagnosis or a reluctance to treat since they do not fit the profile of a typical stroke patient. Methods: We analyzed data from the large national Get With The Guidelines–Stroke registry for acute ischemic stroke patients hospitalized between January 2009 and September 2015. Multivariable models with generalized estimating equations (GEE) were used to test for differences between younger (age 18-40) and older (age > 40) acute ischemic stroke patients, controlling for patient and hospital characteristics including stroke severity. Results: Of 1,320,965 AIS patients admitted to participating hospitals, 2.3% (30,448) were aged 18-40. Among these patients, 12.5% received rt-PA versus 8.8% of those aged >40 (p<0.001). Of patients arriving within 3.5 hours of symptom onset without contraindications, 68.7% of younger patients received IV rt-PA versus 63.3% of older patients (adjusted OR [aOR] 1.30, 95% CI 1.21 to 1.40), without evidence that age-related differences varied by sex (interaction p-value 0.25). Odds ratios of achieving target door-to-CT times and door-to-needle (DTN) times, and outcomes of rtPA-treated patients, are shown in the Table. Conclusions: Young acute ischemic stroke patients did not receive rt-PA treatment at lower rates than older patients. Outcomes were better and the rate of symptomatic intracranial hemorrhage was lower in the young patients. However, younger patients had significantly longer door-to-CT and DTN times, providing an opportunity to improve the care of these patients.

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Abstract TP18: Endovascular Treatment in the Elderly with Acute Ischemic Stroke - Is it Safe in Clinical Practice?

Stroke ◽

10.1161/str.48.suppl_1.tp18 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Thabele M Leslie-Mazwi ◽

Syed F Ali ◽

Sanjeeva R Onteddu ◽

Adewumi D Amole ◽

Mehmet S Akdol ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Univariate Analysis ◽

The Elderly ◽

Stroke Patients ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Younger Patients

Introduction: An overwhelming benefit from endovascular treatment (EVT) of acute ischemic stroke (AIS) has been shown in recent trials, making it the new evidence-based standard of care for ischemic stroke due to anterior circulation large vessel occlusion. We sought to determine usage, safety and efficacy of EVT in patients ≥80 years of age. Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/2009 - 06/2016. Univariate analysis was carried out to compare AIS patients < 80 vs. those ≥ 80yr. Results: Of the total 7,505 AIS patients, 3,722 presented within 12 hr of last known well and of these 334 (334/3722, 9%) underwent EVT. The majority of AIS patients undergoing EVT were younger than 80yr of age (264/334, 79%). Of the patients who underwent EVT, younger patients were more often male, Caucasian, and had stroke risk factors of atrial fibrillation, CAD, hypertension and smokers. The two groups were similar in NIHSS, initial clinical presentation, modified pre-stroke Rankin scale of ≤ 3, and initiation of tPA as a drip and ship or stroke center front-door administration. Higher rates of pneumonia were observed in younger patients while rates of sICH were similar. Younger patients were more often discharged to home/inpatient rehabilitation facility. On univariate analysis, in-hospital mortality was significantly higher in patients ≥ 80yr [Unadj. OR 2.50 (1.24, 5.03), p=0.01], however the strength of the association attenuated substantially after adjusting for significant covariates [Adj. OR 2.34 (0.99, 5.47), p=0.05] (Table). Conclusion: Elderly stroke patients are largely excluded from clinical trials and data are limited on the effectiveness of EVT in this cohort. Our results showed that rate of sICH and adjusted in-hospital mortality was not statistically different between those < 80yr vs. ≥ 80yr. Further studies are needed to explore the functional outcome of the elderly stroke patients undergoing EVT.

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Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

Journal of brain disease ◽

10.4137/jcnsd.s2221 ◽

2009 ◽

Vol 1 ◽

pp. JCNSD.S2221

Author(s):

Byron R. Spencer ◽

Omar M. Khan ◽

Bentley J. Bobrow ◽

Bart M. Demaerschalk

Keyword(s):

Decision Making ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Onset ◽

Stroke Patients ◽

Emergency Medical ◽

Field Assessment ◽

Primary Stroke Center ◽

Stroke Center

Background Emergency Medical Services (EMS) is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC) relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA). Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED) arrival, recordings of time of stroke onset, blood pressure (BP), heart rate (HR), cardiac rhythm, blood glucose (BG), Glasgow Coma Scale (GCS), Cincinnati Stroke Scale (CSS) elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared to be very good overall. Diagnostic accuracy was excellent, field assessment, decision-making, and transport times were very good. There was still room for improvement in documentation of stroke onset and in employment of a common term for acute stroke.

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New Index for Multiple Chronic Conditions Predicts Functional Outcome in Ischemic Stroke

Neurology ◽

10.1212/wnl.0000000000010992 ◽

2020 ◽

Vol 96 (1) ◽

pp. e42-e53

Author(s):

Xiaqing Jiang ◽

Lu Wang ◽

Lewis B. Morgenstern ◽

Christine T. Cigolle ◽

Edward S. Claflin ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Chronic Conditions ◽

Synergistic Effects ◽

Characteristic Curve ◽

Machine Learning Techniques ◽

Validation Dataset ◽

Multiple Chronic Conditions ◽

Corpus Christi ◽

Neurologic Disorders

ObjectiveTo determine whether a new index for multiple chronic conditions (MCCs) predicts poststroke functional outcome (FO), we developed and internally validated the new MCC index in patients with ischemic stroke.MethodsA prospective cohort of patients with ischemic stroke (2008–2017) was interviewed at baseline and 90 days in the Brain Attack Surveillance in Corpus Christi Project. An average of 22 activities of daily living (ADL)/instrumental ADL (IADL) items measured the FO score (range 1–4) at 90 days. A FO score >3 (representing a lot of difficulty with ADL/IADLs) was considered unfavorable FO. A new index was developed using machine learning techniques to select and weight conditions and prestroke impairments.ResultsPrestroke modified Rankin Scale (mRS) score, age, congestive heart failure (CHF), weight loss, diabetes, other neurologic disorders, and synergistic effects (dementia × age, CHF × renal failure, and prestroke mRS × prior stroke/TIA) were identified as important predictors in the MCC index. In the validation dataset, the index alone explained 31% of the variability in the FO score, was well-calibrated (p = 0.41), predicted unfavorable FO well (area under the receiver operating characteristic curve 0.81), and outperformed the modified Charlson Comorbidity Index in predicting the FO score and poststroke mRS.ConclusionsA new MCC index was developed and internally validated to improve the prediction of poststroke FO. Novel predictors and synergistic interactions were identified.Classification of EvidenceThis study provides Class II evidence that in patients with ischemic stroke, an index for MCC predicts FO at 90 days.

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