The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has forced the health workforce to take mitigative measures such as physical distancing, screening, personal protective equipment donning, and confinement on patient care. We aimed to study the outcome of acute stroke patients with suspected, probable, or confirmed COVID-19 in a tertiary referral hospital in Indonesia during the first year of COVID-19 pandemic.METHODS: This was a retrospective study examining all medical records of adult patients suffering from acute stroke with suspected or confirmed COVID-19 who were admitted to R.D. Kandou Hospital, Manado, Indonesia, between March 2020 to March 2021. Clinical and laboratory parameters were compared between subjects with poor and good outcomes based on Glasgow Outcome Scale (GOS), divided into poor outcome (GOS 1-3) and good outcome (GOS 4-5).RESULTS: Fourty-six eligible subjects were enrolled in the study. Based on the GOS, 36 subjects (78.3%) were admitted to the hospital with poor prognosis. On admission, the median Glasgow Coma Scale (GCS) was 11, breathlessness was found in 54.3% of subjects, fever was found in only 15 subjects (32.6%), and the lowest oxygen saturation on admission 95%. We found that GCS significantly related to outcome after controlled for other factors using the logistic regression method (p=0.03; 95% CI=1.08-4.78).CONCLUSION: Lower GCS can be used to predict poor outcome in acute stroke patients with COVID-19.KEYWORDS: COVID-19, acute stroke, Glasgow Coma Scale, outcome, Indonesia

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RESEARCH IN SERUM COPEPTIN CONCENTRATION IN THE ACUTE STROKE PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.5.22 ◽

2017 ◽

pp. 156-163

Author(s):

Thanh Cong Nguyen ◽

Thi Bich Thuan Le ◽

Chuyen Le ◽

Thi Minh Phuong Phan

Keyword(s):

Ischemic Stroke ◽

Glasgow Coma Scale ◽

Intracerebral Hemorrhage ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Stroke Patients ◽

Nihss Score ◽

Coma Scale

Objectives: To determine serum Copeptin concentration and correlation between serum Copeptin concentration with some major predictors of acute stroke patients (ischemic stroke and intracerebral hemorrhage). Subjects and Methods: Cross-sectional descriptive study with 72 patients (40 acute ischemic stroke patients and 32 intracerebral hemorrhage patients at Hue University Hospital. Data processing method is according to usual medical statistics and SPSS 20.0. Results: 1. The serum Copeptin concentration in the patients with acute stroke: - The serum Copeptin concentration in the patients with acute ischemic stroke was 11.28 ± 5.2 pmol/L (admission) and 8.81 ± 4.94 pmol/L (after 7 days). - The serum Copeptin concentration in the patients with acute intracerebral hemorrhage was 9.17 ± 7.97 pmol/L (admission) and 7.14 ± 6.62 pmol/L (after 7 days). - The serum Copeptin concentration in the patients with acute stroke at admission and after 7 days there was not statistically significant difference between female and male (p > 0.05). 2. The correlation between serum Copeptin concentration and severity of acute stroke patients: - The serum Copeptin concentration correlated positively with size of injury (ischemic stroke: r = 0.743; p< 0.001 and intracerebral hemorrhage: r = 0.502; p= 0.003). - The serum Copeptin concentration in the acute stroke patients correlated positively with NIHSS score at admission (ischemic stroke: r = 0.657, p < 0.001 and intracerebral hemorrhage: r = 0.408, p = 0.021). - The serum Copeptin concentration in the acute stroke patients correlated positively with NIHSS score after 7 days (ischemic stroke: r = 0.486, p < 0.001 and intracerebral hemorrhage: r = 0.359, p = 0.044). - The serum Copeptin concentration in the acute stroke patients correlated negatively with Glasgow Coma Scale score at admission (ischemic stroke: r = - 0.564, p < 0.001 and intracerebral hemorrhage: r = - 0.466, p = 0.007).The serum Copeptin concentration in the acute stroke patients correlated negatively with Glasgow Coma Scale score after 7 days (ischemic stroke: r = - 0.499, p < 0.001 and intracerebral hemorrhage: r = - 0.38, p = 0.032). Conclusions: There was correlation between serum Copeptin concentration with severity of acute stroke patients. Key words: Copeptin, acute stroke, ischemic stroke, intracerebral hemorrhage

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Predicting Pneumonia in Acute Stroke Patients Using the Glasgow Coma Scale Score

Annals of Epidemiology ◽

10.1016/j.annepidem.2017.07.073 ◽

2017 ◽

Vol 27 (8) ◽

pp. 522

Author(s):

Malinee Neelamegam ◽

Sharad Malavade ◽

Irene Looi ◽

Zariah Abdul Aziz ◽

Norsima Nafizah Sidek

Keyword(s):

Glasgow Coma Scale ◽

Acute Stroke ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Stroke Patients ◽

Coma Scale

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Abstract T P299: Ambulatory Status: A Protective Mechanism against Venous Thromboembolism in Acute Stroke Patients

Stroke ◽

10.1161/str.46.suppl_1.tp299 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jason-Flor Sisante ◽

Michael Abraham ◽

Sandra Billinger ◽

Manoj Mittal

Keyword(s):

Venous Thromboembolism ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Acute Stroke ◽

Early Mobilization ◽

Protective Mechanism ◽

Stroke Patients ◽

Ambulatory Status ◽

Stroke Type ◽

The Relationship

Introduction: Deep vein thrombosis (DVT) is reported in 23% to 50% of hemiplegic stroke survivors and the highest rate of incidence occurs within one week of stroke onset. Pulmonary embolism (PE) is reported in up to 5% of stroke patients. There is limited data about the relationship of ambulatory status and the rate of venous thromboembolism (VTE) following a stroke. Hypothesis: The goal of our retrospective cohort study was to understand the relationship between VTE and a patient’s ambulatory status, adjusting for age, gender, and stroke type (ischemic, intracerebral hemorrhage, or subarachnoid hemorrhage). We assessed the hypothesis that the stroke patients who are able to ambulate during hospitalization would have lower rates of DVT and PE. Methods: We retrospectively analyzed 1670 acute stroke patients who were admitted to an academic comprehensive stroke center between Feb 2006 and May 2014. “Get with the guideline data” was used to identify stroke patients and their ambulatory status (yes/no). VTE was identified using discharge diagnosis. Chi square test and logistic regression methods were used for statistical analysis. Results: Mean age was 64.9 ± 14.6 years with 51% men. 1138 (68%) patients were classified as having ischemic stroke; 291 (17.5%) patients had intracerebral hemorrhage; and 241 (14.5%) patients had subarachnoid hemorrhage. During hospitalization, 444 (27%) were ambulatory. Patients able to ambulate during hospitalization had less rate of DVT (6.3% vs 15.3%; p<0.0001) and PE (2.9% vs 5.3%; p=0.04), when compared to non-ambulating patients. After adjusting for age, gender, and stroke type; patients who were able to ambulate still had lower rates of DVT (OR: 0.42, 95% CI 0.27-0.63) and PE (OR: 0.49, 95% CI 0.25-0.88). Conclusion: In conclusion, our findings suggest that the patient’s ambulatory status during hospitalization is an independent predictor of VTE. Further research is needed to understand if early mobilization in non-ambulatory stroke patients would have similar protective effect against VTE or not.

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Abstract TP235: Deterioration and Improvement in the Field: Comparative Detection by Los Angeles Motor Scale and Glasgow Coma Scale in Acute, EMS-transported Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tp235 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Anita Tipirneni ◽

Kristina Shkirkova ◽

Nerses Sanossian ◽

Sidney Starkman ◽

Scott Hamilton ◽

...

Keyword(s):

Cerebral Ischemia ◽

Los Angeles ◽

Glasgow Coma Scale ◽

Intracranial Hemorrhage ◽

Stroke Patients ◽

Coma Scale ◽

Acute Cerebral Ischemia ◽

Stroke Evolution ◽

Global Impression Of Change ◽

Los Angeles Motor Scale

Background: Stroke evolution after hospital arrival is well characterized for acute cerebral ischemia and intracranial hemorrhage. But with the advent of patient routing to designated stroke centers, and of prehospital stroke therapeutic trials, it is important to characterize stroke evolution in the earliest, prehospital moments of onset. Initial studies have prehospital evolution using serial Glasgow Coma Scale (GCS) assessment; however, GCS assesses level of consciousness rather than focal deficits. Methods: In the NIH FAST-MAG trial database, we analyzed patient deficit evolution from time of first paramedic assessment to early post-arrival assessment in the ED, using serial scores on the GCS, serial scores on the Los Angeles Motor Scale (LAMS) (a prehospital stroke deficit measure), and the Paramedic Global Impression of Change (PGIC) score, a 5 point Likert paramedic-clinician score. Results: Among 1632 acute, EMS-transported neurovascular disease patients, 1,245 (76.3%) had a final diagnosis of acute cerebral ischemia and 387 (23.7%) of acute intracranial hemorrhage. Time of paramedic initial assessment was median 23 mins (IQR 14-41) after onset and time of early ED assessment 58 mins (IQR 46-78). Considering score changes by 2 or more as salient, overall the LAMS and GCS indicated approximately equal frequencies of prehospital deterioration (LAMS 11.1%, GCS 12.0%), but the LAMS indicated higher frequencies of prehospital improvement (LAMS 24.5% vs GCS 5.7%, p<0.001), due to the ceiling constraint of the GCS. The LAMS correlated more strongly than the GCS with the paramedic global impression of change among all patients, r=0.31 vs 0.19, and especially in acute cerebral ischemia patients, r=0.27 vs 0.08). The prehospital course differed by stroke subtype on the LAMS: acute cerebral ischemia: improved 30.7%, worsened 7.1%, stable 62.25%; intracranial hemorrhage: improved 4.5%, worsened 24.2%, stable 71.3%. Conclusions: Focal deficit scales are superior to the GCS in characterizing prehospital stroke evolution. Change in neurologic status occurs in more than one-third of acute stroke patients during transport and the early ED, with improvement more common in acute cerebral ischemia and deterioration more common in ICH.

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