Abstract T MP86: A Prospective Study of the Effect of Dehydration on Stroke Severity and Short Term Outcome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mona N Bahouth ◽  
Argye Hillis ◽  
Rebecca Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Urine Specific Gravity ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Short Term ◽  
Term Outcome ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Many ischemic stroke patients present to the hospital in a state of dehydration. We hypothesized that patients who were dehydrated at the time of acute stroke would have more severe stroke and worse short term outcomes. Methods: We enrolled consecutive ischemic stroke patients within 12 hours from their last normal neurological exam at a single academic health system. Patients with renal failure or who were unable to undergo MRI were excluded. Surrogate markers for dehydration were defined as BUN/Creatinine ratio >15 and urine specific gravity >1.010. Stroke severity was determined based on clinical examination (NIHSS score) and lesion volume measured on diffusion weighted MRI. The primary outcome of interest was change in NIHSS from admission to discharge. Results: We surveyed 383 ischemic stroke admissions to our comprehensive stroke center. Of these, 168 met inclusion criteria with 126/168 (75%) having complete laboratory and MRI data. 44% of our patients were dehydrated at the time of admission, with no difference in demographics between the dehydrated and hydrated groups. Baseline NIHSS (6.7 vs 7.3; p=0.63) and lesion volumes (12 vs 16; p=0.48) were similar in the two groups. 42% of dehydrated patients were in the worst short term quartile of NIHSS change, as compared with 17% of the hydrated group (p=0.02). Dehydration remained a significant predictor of having the worst NIHSS change, after adjustment for age, initial NIHSS, lesion volume, and admission glucose (OR=4.34, 95% CI 1.75-10.76). Conclusions: Nearly half of acute stroke patients admitted to the hospital are dehydrated by surrogate laboratory markers. Acute stroke patients with markers of dehydration demonstrate greater worsening in NIHSS scores as compared with hydrated patients, independent of infarct size. Results suggest an opportunity for an inexpensive and globally available treatment to optimize functional outcomes of the stroke patient.

SERUM ALBUMIN LEVELS AND ITS CORRELATION WITH SHORT TERM OUTCOME IN ACUTE ISCHEMIC STROKE PATIENTS

2021 ◽  
pp. 12-13
Author(s):  
Avtar Singh Dhanju ◽  
Thiyagu K ◽  
Ajay Chhabra ◽  
Pashaura Singh
Keyword(s):  
Ischemic Stroke ◽  
Serum Albumin ◽  
Acute Ischemic Stroke ◽  
Albumin Level ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Short Term ◽  
Term Outcome ◽  
Nihss Score ◽  
The Relationship

Aim:The study was undertaken with the aim to establish the denite correlation between serum albumin levels and outcome of ischemic stroke. Methodology: The present observational study was conducted on 100 acute ischemic stroke patients meeting inclusion and exclusion criteria. All patients were investigated for hypoalbuminemia and their stroke severity was assessed by NIHSS score on day 1 and day 7. The relationship between admission albumin levels, NIHSS values and outcome of those patients was ascertained. Results: There was increased prevalence of hypoalbuminemia in AIS patients and there was signicant correlation between NIHSS score on day 1&7, mortality and hypoalbuminemia in AIS patients and there was signicant association between high NIHSS score and mortality in AIS patients. Conclusion: serum albumin is an independent predictor of functional outcome following an acute ischemic stroke and serum albumin level is inversely correlated with severity of stroke at presentation.

National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Akiko Kada ◽  
Kuniaki Ogasawara ◽  
Takanari Kitazono ◽  
Kunihiro Nishimura ◽  
Nobuyuki Sakai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Temporal Trends ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

scholarly journals Pilot study of volume contracted state and hospital outcome after stroke

2018 ◽  
Vol 8 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Mona N. Bahouth ◽  
Andrew Gaddis ◽  
Argye E. Hillis ◽  
Rebecca F. Gottesman
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Acute Stroke ◽  
Urine Specific Gravity ◽  
Consecutive Series ◽  
Stroke Patients ◽  
Multivariable Analyses ◽  
Stroke Center ◽  
Time Of Admission ◽  
The Relationship

BackgroundAn increasing body of research suggests that acute stroke patients who are dehydrated may have worsened functional outcomes. We sought to explore the relationship between a volume contracted state (VCS) at the time of ischemic stroke and hospital outcomes as compared with euvolemic patients.MethodsWe enrolled a consecutive series of ischemic stroke patients from a single academic stroke center within 12 hours from stroke onset. VCS was defined via surrogate markers (blood urea nitrogen/creatinine ratio >15 and urine specific gravity >1.010). The primary outcome was change in NIH Stroke Scale (NIHSS) score from admission to discharge. Multivariable analyses included adjustment for demographics and infarct size.ResultsOver an 11-month study period, 168 patients were eligible for inclusion. Of the126 with complete laboratory and MRI data, 44% were in a VCS at the time of admission. Demographics were similar in both the VCS and euvolemic groups, as were baseline NIHSS scores (6.7 vs 7.3; p = 0.63) and infarct volumes (12 vs 16 mL; p = 0.48). However, 42% of patients in a VCS demonstrated early clinical worsening, compared with 17% of the euvolemic group (p = 0.02). A VCS remained a significant predictor of worsening NIHSS in adjusted models (odds ratio 4.34; 95% confidence interval 1.75–10.76).ConclusionsAcute stroke patients in a VCS demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Results suggest an opportunity to explore current hydration practices.

Abstract W P212: The Effect Of Pre-hospital Notification On Time To Head Ct, Stroke Specialist Arrival, And Tpa Administration For Hispanic Patients With Acute Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jonathan McCoy ◽  
Ralph Fader ◽  
Colleen Donovan ◽  
Robert Eisenstein ◽  
Pamela Ohman-Strickland ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Independent Effect ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Head Ct ◽  
Logistic Regression Models ◽  
Hispanic Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Hispanics have an increased incidence of ischemic stroke but may be less likely to use Emergency Medical Services (EMS) for stroke care. Objective: To examine disparities in pre-hospital triage and emergent evaluation of Hispanic stroke patients. We hypothesized that Hispanic stroke patients with pre-hospital notification experience less delay in emergent evaluation but the reduction may not be as pronounced as general stroke patients. Methods: Retrospective cohort study of all emergency department patients alerted as Brain Attack (BAT) between January 1, 2009 and August 31, 2012, at an urban comprehensive stroke center. We collected demographics, co-morbidities, and stroke severity from a quality assurance database. Outcome variables included EMS utilization, pre-hospital BAT activation, head CT timing & tissue plasminogen activator (TPA) timing. Effects of ethnicity and pre-hospital notification on evaluation and treatment times were measured using multivariate logistic regression models. The study was IRB approved. Results: During the study period, 832(64 Hispanic) patients were alerted as Brain Attacks. Hispanic patients were younger 56±17 vs. 68±16 years (p<0.0001), had trends for less EMS utilization (walk-in 35% vs. 22%) and lower NIHSS 9.3±4.3 vs. 12.8±8.3 (p=0.06), but did not differ in comorbidities. Patients with pre-hospital notification had significantly shorter times to stroke specialist arrival, door to head CT, and door to TPA irrespective of ethnicity. However, ethnicity did have independent effect on time to TPA administration. Please see Table 1. Conclusion: Pre-hospital notification is associated with faster stroke evaluation and treatment, including among Hispanic patients with acute stroke. Further study is needed to examine if outreach to increase EMS utilization will decrease disparities in this population.

scholarly journals Role of some inflammatory biomarkers in prediction of short-term outcome in acute ischemic stroke

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Yosria Abd Al Hameed AlTaweel ◽  
Rania Sanad Nageeb ◽  
Pakinam Mahmoud Metwally ◽  
Ahmed Elsayed Badawy
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Short Term ◽  
Laboratory Assessment ◽  
Term Outcome ◽  
Neutrophil Lymphocyte Ratio ◽  
Short Term Outcome ◽  
Wbc Count

Abstract Background Several factors affect acute ischemic stroke (AIS) outcomes. Objective This study aimed to assess the role of the leukocyte count, neutrophil/lymphocyte ratio (NLR), and c reactive protein (CRP) as early predictors of outcome in AIS patients. Methods This study was conducted on 60 AIS patients. They were subjected to detailed history taking, clinical examination, brain imaging, and laboratory assessment including the CRP, white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and NLR which is calculated by dividing ANC by ALC. Neurological scales were used to assess the level of consciousness by the Glasgow Coma Scale (GCS) and stroke severity by the National Institute of Health Stroke Scale (NIHSS) at the first 48 h of stroke onset as well as 1 week and 2 weeks later for the assessment of short-term functional neurological outcome. Results Sixty percent of the patients had unfavorable outcomes assessed by the Modified Rankin Scale (mRS). Patients with unfavorable outcomes had higher NIHSS scores. NLR was positively correlated with WBC count, ANC, and CRP. The higher WBC, NLR, and NIHSS, the unfavorable the outcome was. Conclusion The higher WBC, the NLR, and the level of CRP at the onset of AIS, the more severe stroke and the poorer the short-term outcome are expected.

Abstract 3313: Outcomes of “Drip-and-Ship” Paradigm Among Patients with Acute Ischemic Stroke. Results of a State Wide Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Gustavo J Rodriguez ◽  
M. Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Population Based ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Stroke Patients ◽  
Frequency Distributions ◽  
Number Of Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: “Drip-and-ship” denotes patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 hours to a comprehensive stroke center. Although drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population based level. Methods: State-wide estimates of thrombolysis, associated in-hospital outcomes and mortality were obtained from 2008-2009 Minnesota Hospital Association (MHA) data. Patient numbers and frequency distributions were calculated for state-wide sample of patients hospitalized with a primary diagnosis of ischemic stroke. Patients outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. Results: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n=473) or drip-and-ship paradigm (n=129). The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with drip-and-ship paradigm (8.5% versus 3.1, p=0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or drip-and-ship paradigm (5.9% versus 7.0%). The mean hospital charges were $65,669 for primary ED arrival and $47,850 for drip-and-ship treated patients (p<0.001). Conclusions: The results of drip-and-ship paradigm compare favorably with IV rt-PA treatment through primary ED arrival in this state-wide study.

Abstract 83: Etiology of Late Right-to-Left Shunting on Transcranial Doppler in Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adam de Havenon ◽  
Anne Moore ◽  
Nicholas Freeberg ◽  
Ali Sultan-Qurraie ◽  
David Tirschwell
Keyword(s):  
Ischemic Stroke ◽  
Transcranial Doppler ◽  
Inclusion Criteria ◽  
Contrast Injection ◽  
Stroke Patients ◽  
Stroke Etiology ◽  
Standard Component ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Toast Classification

Background: An echocardiogram or transcranial Doppler (TCD) bubble study to test for a right-to-left shunt (RLS) is a standard component of an ischemic stroke workup. Because the pathway for an intracradiac RLS, such as a patent foramen ovale (PFO), is more direct, it has been proposed that the late appearance of a RLS suggests an extracardiac pathway. We sought to characterize a cohort of ischemic stroke patients with late RLS (LRLS) on TCD. Methods: We searched the medical record of a Comprehensive Stroke Center for patients with ischemic stroke who had a TCD and echocardiogram bubble study during 2011-2013. LRLS was defined as TCD bubbles appearing more than 18 cardiac cycles after contrast injection. TOAST stroke etiology classification was performed by a vascular neurologist blinded to TCD results. Results: 124 patients met inclusion criteria, of which 67/124 (54%) had RLS on TCD; and 32/67 (48%) had LRLS. In the 35/67 patients with normal RLS on TCD, 23% did not have RLS on echocardiography, consistent with prior reports of TCD’s superiority for detecting RLS. In the 32/67 patients with LRLS on TCD, 56% were negative for RLS by echocardiography. In the cohort of 124 patients, the percentage of TOAST classification 4 (stroke of other determined cause) was 26%, while in the 32 patients with LRLS the percentage of TOAST 4 was significantly higher at 52%(p=0.005) (Table 1). The increase in TOAST 4 in LRLS patients was created by an even distribution of decreases in the other TOAST categories. The most common TOAST 4 stroke etiology in LRLS patients was PFO with concurrent deep venous thrombosis. Conclusion: This preliminary data supports prior studies that have shown superiority of TCD over echocardiography for detection of RLS, and challenge the prevailing notion that extracardiac shunt, such as pulmonary AVM, is the most common cause of LRLS in ischemic stroke patients. This subgroup of patients warrants further research to clarify mechanisms of ischemic stroke in patients with RLS.

Abstract T P267: Development of an EMS Interfacility Ground Transport Protocol for Patients During/After IV tPA Administration for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kerrin Connelly ◽  
Rishi Gupta ◽  
Raul Nogueira ◽  
Arthur Yancey ◽  
Alexander Isakov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Transport Protocol ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Public ◽  
State Office ◽  
Stroke Center ◽  
Iv Tpa

Purpose: To standardize the care of acute stroke patients who receive IV tPA being transported by ground EMS from a treating hospital to a stroke center. Background: National consensus guidelines exist for the hospital management of patients receiving IV tPA for acute ischemic stroke. Such patients require close monitoring and management to minimize risk of clinical deterioration. Although patients are often emergently transported from local hospitals to a stroke center, there are no treatment specific national guidelines for managing such patients enroute. As a result, there is a need to develop and implement a standardized approach to guide EMS personnel, particularly in states like Georgia where the public health burden of stroke is high. Methods: In 2012, the “Georgia EMS Interfacility Ground Transport Protocol for Patients during/after IV tPA Administration for Acute Ischemic Stroke” was developed in conjunction with the Georgia Coverdell Acute Stroke Registry, the Georgia State Office of EMS, a representative group of Georgia hospitals and EMS providers. Stakeholders were brought together with the goal of creating a unified statewide protocol. The intent was to create a streamlined protocol which could be readily implemented by pre-hospital care providers. Results: Stakeholders discussed challenges and opportunities to change the process of pre-hospital care. Challenges included recognition of the broad diversity of EMS providers representing over 250 agencies in the state. Opportunities included establishing the framework for greater collaboration across organizations and providers. The final protocol was endorsed by both the Georgia Coverdell Acute Stroke Registry and the State Office of EMS, and distributed to all EMS regions in Georgia. EMS agencies are currently implementing the protocol. Conclusion: Engaging a diverse group of statewide stakeholders to develop a new treatment protocol enhances success in implementation and serves to further the public health mission of improving care of acute stroke patients.

Abstract P855: Importance of Compliance in Dysphagia Screening in Acute Stroke Care

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Patty Noah ◽  
Melanie Henderson ◽  
Rebekah Heintz ◽  
Russell Cerejo ◽  
Christopher T Hackett ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Aspiration Pneumonia ◽  
Hemorrhagic Stroke ◽  
Oral Intake ◽  
Stroke Care ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Chi Square ◽  
Stroke Center

Introduction: Dysphagia occurs in up to two thirds of stroke patients and can lead to serious complications such as aspiration pneumonia, which is also linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia assessment before oral intake in stroke patients regardless of initial stroke severity. Several studies have described registered nurses’ competency in terms of knowledge and skills regarding dysphagia screening. We aimed to examine the rate of aspiration pneumonia compared to the rate of dysphagia screening. Methods: A retrospective analysis of prospectively collected data at a single tertiary stroke center was carried out between January 2017 and June 2020. Data comparison was completed utilizing ICD-10 diagnosis codes to identify aspiration pneumonia in ischemic and hemorrhagic stroke patients. The data was reviewed to compare the compliance of a completed dysphagia screen prior to any oral intake to rate of aspiration pneumonia. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of aspiration pneumonia diagnosis in the ischemic and hemorrhagic stroke patients. Results: We identified 3320 patient that met inclusion criteria. 67% were ischemic strokes, 22% were intracerebral hemorrhages and 11% were subarachnoid hemorrhages. Compliance with dysphagia screening decreased from 94.2% (n=1555/1650) in 2017-2018 to 74.0% (n=1236/1670) in 2019-2020, OR=0.17 (95%CI 0.14 - 0.22), p < 0.0001. Aspiration pneumonias increased from 58 (3.5%) in 2017-2018 to 77 (4.6%) in 2019-2020, but this difference was not statistically significant, OR=0.75 (95%CI 0.53 - 1.07), p = 0.11. Conclusion: We noted that the decrease in compliance with completing a dysphagia screen in patients with acute stroke prior to any oral intake was associated with a higher trend of aspiration pneumonia.

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