scholarly journals Severe Dysphagia Predicts Poststroke Fever

Stroke ◽  
2021 ◽  
Author(s):  
Sebastian Stösser ◽  
Matthias Gotthardt ◽  
Beate Lindner-Pfleghar ◽  
Eric Jüttler ◽  
Rebecca Kassubek ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Hemorrhagic Stroke ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Severe Dysphagia ◽  
Multivariable Analyses ◽  
Speech Therapist ◽  
Common Observation ◽  
Risk Of Aspiration ◽  
Swallowing Assessment

Background and Purpose: Fever is a common observation after ischemic or hemorrhagic stroke and is associated with a worse clinical outcome. Infections, stroke severity, preexisting medical conditions, insertion of catheters, and dysphagia have been implicated in causing poststroke fever. Given that dysphagia has not been evaluated in detail yet, the aim of this study was to investigate if the severity of dysphagia assessed by a detailed swallowing assessment predicts poststroke fever. Methods: In this retrospective monocentric cohort study, all patients admitted for ischemic or hemorrhagic stroke within 12 months were included. Patients underwent a detailed standardized swallowing assessment including a clinical exam by a speech therapist and fiberoptic endoscopic evaluation in a subset of patients. Patients who developed fever within 5 days were compared with patients without fever regarding swallowing parameters and other clinical characteristics relevant for the prediction of poststroke fever. Results: Nine hundred twenty-three patients with acute ischemic or hemorrhagic stroke were included. One hundred twenty-seven (13.8%) patients developed fever. In multivariable analyses, fever was independently predicted by moderate-to-severe dysphagia in clinical assessments (odds ratio [95% CI], 3.05 [1.65–5.66]) and also by dysphagia with proven risk of aspiration as a combined end point of clinical and instrumental assessments (1.79 [1.07–3.00]). Other independent predictors were stroke severity (odds ratio, 1.06 per point on the National Institutes of Health Stroke Scale score [1.01–1.11]) and the presence of an urinary catheter (odds ratio, 2.03 [1.13–3.65]). Conclusions: Severe dysphagia evaluated by a detailed clinical assessment complemented by instrumental testing predicts the development of poststroke fever. Early identification of patients with severe dysphagia after stroke followed by consequent monitoring and treatment might be effective in reducing poststroke fever.

scholarly journals Who Is Classified as Untestable on Brief Cognitive Screens in an Acute Stroke Setting?

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 95 ◽  
Author(s):  
Emma Elliott ◽  
Bogna A. Drozdowska ◽  
Martin Taylor-Rowan ◽  
Robert C. Shaw ◽  
Gillian Cuthbertson ◽  
...  
Keyword(s):  
Cognitive Assessment ◽  
Odds Ratio ◽  
National Institutes Of Health ◽  
Screening Tests ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Cognitive Screening ◽  
Dementia Diagnosis ◽  
Nihss Score ◽  
Test Completion

Full completion of cognitive screening tests can be problematic in the context of a stroke. Our aim was to examine the completion of various brief cognitive screens and explore reasons for untestability. Data were collected from consecutive stroke admissions (May 2016–August 2018). The cognitive assessment was attempted during the first week of admission. Patients were classified as partially untestable (≥1 test item was incomplete) and fully untestable (where assessment was not attempted, and/or no questions answered). We assessed univariate and multivariate associations of test completion with: age (years), sex, stroke severity (National Institutes of Health Stroke Scale (NIHSS)), stroke classification, pre-morbid disability (modified Rankin Scale (mRS)), previous stroke and previous dementia diagnosis. Of 703 patients admitted (mean age: 69.4), 119 (17%) were classified as fully untestable and 58 (8%) were partially untestable. The 4A-test had 100% completion and the clock-draw task had the lowest completion (533/703, 76%). Independent associations with fully untestable status had a higher NIHSS score (odds ratio (OR): 1.18, 95% CI: 1.11–1.26), higher pre-morbid mRS (OR: 1.28, 95% CI: 1.02–1.60) and pre-stroke dementia (OR: 3.35, 95% CI: 1.53–7.32). Overall, a quarter of patients were classified as untestable on the cognitive assessment, with test incompletion related to stroke and non-stroke factors. Clinicians and researchers would benefit from guidance on how to make the best use of incomplete test data.

scholarly journals Acute Ischemic Stroke in Patients With COVID-19

Stroke ◽  
2021 ◽  
Vol 52 (5) ◽  
pp. 1826-1829
Author(s):  
Pratyaksh K. Srivastava ◽  
Shuaiqi Zhang ◽  
Ying Xian ◽  
Hanzhang Xu ◽  
Christine Rutan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adverse Outcomes ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Younger Age ◽  
Increased Risk ◽  
Scale Scores ◽  
Get With The Guidelines

Background and Purpose: Studies suggest an increased risk of adverse outcomes among patients with acute ischemic stroke (AIS) and coronavirus disease 2019 (COVID-19). Methods: Using Get With The Guidelines–Stroke, we identified 41 971 patients (AIS/COVID-19: 1143; AIS/no COVID-19: 40 828) with AIS hospitalized between February 4, 2020 and June 29, 2020, from 458 Get With The Guidelines–Stroke hospitals with at least one COVID-19 case and evaluated clinical characteristics, treatment patterns, and outcomes. Results: Compared with patients with AIS/no COVID-19, those with AIS/COVID-19 were younger, more likely to be non-Hispanic Black, Hispanic, or Asian, more likely to present with higher National Institutes of Health Stroke Scale scores, and had greater proportions of large vessel occlusions. Rates of thrombolysis and thrombectomy were similar between the groups. Door to computed tomography (median 55 [18–207] versus 35 [14–99] minutes, P <0.001), door to needle (59 [40–82] versus 46 [33–64] minutes, P <0.001), and door to endovascular therapy (114 [74–169] versus 90 [54–133] minutes, P =0.002) times were longer in the AIS/COVID-19 cohort. In adjusted models, patients with AIS/COVID-19 had decreased odds of discharge with modified Rankin Scale score of ≤2 (odds ratio, 0.65 [95% CI, 0.52–0.81], P <0.001) and increased odds of in-hospital mortality (odds ratio, 4.34 [95% CI, 3.48–5.40], P <0.001). ConclusionS: This analysis demonstrates younger age, greater stroke severity, longer times to evaluation and treatment, and worse morbidity and mortality in patients with AIS/COVID-19 compared with those with AIS/no COVID-19.

scholarly journals Ultra-Early Intravenous Stroke Thrombolysis

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2913-2916 ◽  
Author(s):  
Daniel Strbian ◽  
Peter Ringleb ◽  
Patrik Michel ◽  
Lorenz Breuer ◽  
Jyrki Ollikainen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Treatment Time ◽  
Continuous Variable ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Excellent Outcome ◽  
Stroke Thrombolysis ◽  
Treatment Onset

Background and Purpose— We previously reported increased benefit and reduced mortality after ultra-early stroke thrombolysis in a single center. We now explored in a large multicenter cohort whether extra benefit of treatment within 90 minutes from symptom onset is uniform across predefined stroke severity subgroups, as compared with later thrombolysis. Methods— Prospectively collected data of consecutive ischemic stroke patients who received IV thrombolysis in 10 European stroke centers were merged. Logistic regression tested association between treatment delays, as well as excellent 3-month outcome (modified Rankin scale, 0–1), and mortality. The association was tested separately in tertiles of baseline National Institutes of Health Stroke Scale. Results— In the whole cohort (n=6856), shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome ( P <0.001). Every fifth patient had onset-to-treatment time≤90 minutes, and these patients had lower frequency of intracranial hemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time≤90 minutes was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12 (odds ratio, 1.37; 95% confidence interval, 1.11–1.70; P =0.004), but not in patients with baseline National Institutes of Health Stroke Scale>12 (odds ratio, 1.00; 95% confidence interval, 0.76–1.32; P =0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78–1.39; P =0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14–2.01; P <0.01) was found when considering modified Rankin scale 0 as outcome (to overcome the possible ceiling effect from spontaneous better prognosis of patients with mild symptoms). Ultra-early treatment was not associated with mortality. Conclusions— IV thrombolysis within 90 minutes is, compared with later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.

scholarly journals Initial Stroke Severity in Patients With Atrial Fibrillation According to Antithrombotic Therapy Before Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2733-2741 ◽  
Author(s):  
Yo Han Jung ◽  
Young Dae Kim ◽  
Jinkwon Kim ◽  
Sang Won Han ◽  
Mi Sun Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Scale Score ◽  
Neurological Deficit ◽  
Odds Ratio ◽  
Medication Use ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Antithrombotic Medication

Background and Purpose: Atrial fibrillation (AF) is the leading cause of ischemic stroke. Preventive antithrombotic use, especially for anticoagulation, reduces the incidence of ischemic stroke in patients with AF. Using data from the nationwide multicenter stroke registry, we investigated the trends of preceding antithrombotic medication use in patients with acute ischemic stroke (AIS) with AF and its association with initial stroke severity and in-hospital outcomes. Methods: This study included 6786 patients with AIS with known AF before stroke admission across 39 hospitals between June 2008 and December 2018. We collected the data on antithrombotic medication use (no antithrombotic/antiplatelet/anticoagulant) preceding AIS. Initial stroke severity was measured using the National Institutes of Health Stroke Scale, and in-hospital outcome was determined by modified Rankin Scale score at discharge. Results: During the study period, anticoagulant use continued to increase. However, nearly one-third of patients with AIS with known AF did not receive antithrombotics before stroke. Initial National Institutes of Health Stroke Scale scores varied according to preceding antithrombotic therapy ( P <0.001). It was higher in patients who did not receive antithrombotics than in those who received antiplatelets or anticoagulants (median National Institutes of Health Stroke Scale score: 8 versus 7 and 8 versus 6, respectively). Favorable outcome at discharge (modified Rankin Scale score, 0–2) was more prevalent in patients who received antiplatelets or anticoagulants ( P <0.001). Use of antiplatelets (odds ratio, 1.23 [95% CI, 1.09–1.38]) and anticoagulants (odds ratio, 1.31 [95% CI, 1.15–1.50]) was associated with a mild initial neurological deficit (National Institutes of Health Stroke Scale score ≤5) in patients with AIS with AF. Conclusions: Throughout the study period, the proportion of patients taking anticoagulants increased among patients with AIS with known AF. However, a large portion of AF patients still did not receive antithrombotics before AIS. Furthermore, prehospitalization use of anticoagulants was associated with a significantly higher likelihood of a mild initial neurological deficit and favorable outcome at discharge.

scholarly journals Post-stroke dysphagia: frequency, risk factors, and topographic representation: hospital-based study

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Eman M. Khedr ◽  
Mohamed A. Abbass ◽  
Radwa K. Soliman ◽  
Ahmed F. Zaki ◽  
Ayman Gamea
Keyword(s):  
Risk Factors ◽  
Hemorrhagic Stroke ◽  
Lesion Size ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Swallowing Function ◽  
Post Stroke ◽  
Ischemic Group ◽  
Outcome Severity ◽  
The Mean

Abstract Background The frequency of dysphagia varies considerably across literature. Post-stroke dysphagia is a common cause of increased morbidity and length of hospitalization. This study aimed to estimate the frequency, risk factors of dysphagia following first-ever ischemic or hemorrhagic stroke and its neuroradiological correlation. Methods Two hundred fifty patients (180 ischemic and 70 hemorrhagic strokes) with first-ever stroke were recruited within 72 h of onset. Detailed history, neurological examination, and computed tomography and/or magnetic resonance were done for each patient. Severity of stroke was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Swallowing function was assessed by water swallowing test (WST) and dysphagia outcome severity scale (DOSS). Results Ninety-eight (39.2%) of all stroke patients had dysphagia, 57 (31.7%) of ischemic group, 41 (58.6%) of hemorrhagic group. The mean age of ischemic group with dysphagia was older than ages of non-dysphagic and older than hemorrhagic stroke with dysphagia group. The mean total NIHSS was higher in dysphagic group than non-dysphagic group in both ischemic and hemorrhagic stroke. Dysphagia in ischemic group was highly associated with diabetes mellitus (DM), hypertension (HTN), and atrial fibrillation (AF). Dysphagia was commonly associated with middle cerebral artery (MCA), brainstem, and capsular infarctions as well as with intracerebral hemorrhage (ICH) with ventricular extension. Stroke severity and lesion size were the main determinant of dysphagia severity. Conclusions The frequency of post-stroke dysphagia is consistent with other studies. Advanced age, DM, HTN, and AF were the main risk factors. MCA, brain stem, capsular infarctions, and ICH with ventricular extension were frequently associated with dysphagia. Stroke severity and lesion size were independent predictors of dysphagia severity.

scholarly journals Risk Factors for Stroke Associated Pneumonia

2019 ◽  
Vol 7 (24) ◽  
pp. 4416-4419
Author(s):  
Do Quyet ◽  
Nguyen Minh Hien ◽  
Mai Xuan Khan ◽  
Dai Dinh Pham ◽  
Do Duc Thuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
High Risk ◽  
Odds Ratio ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Swallowing Disorder ◽  
Stroke Patients ◽  
Frequent Complication

BACKGROUND: Stroke patients are at high risk for stroke-associated pneumonia (SAP). If patients suffer from pneumonia their prognosis will worsen. AIM: To identify factors that increases the risk of SAP in stroke patients. METHODS: A group of 508 patients hospitalized within 5 days after the onset of stroke were enrolled prospectively. RESULTS: The incidence of SAP was 13.4%. Some major risk factors for SAP are: mechanical ventilation (MV) had odds ratio (OR) 16.4 (p <0.01); the National Institutes of Health Stroke Scale (NIHSS) > 15 OR 9.1 (p <0.01); the Gugging Swallowing Screen (GUSS) 0-14 OR 11.7 (p <0.01). CONCLUSION: SAP is a frequent complication. We identified some risk factors of SAP, especially stroke severity (NIHSS > 15), swallowing disorder (GUSS < 15) and mechanical ventilation.

Economic Impact of Poststroke Delirium and Associated Risk Factors: Findings From a Prospective Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Carl Moritz Zipser ◽  
Jeremy Werner Deuel ◽  
Jeremia Philipp Oskar Held ◽  
Jutta Ernst ◽  
Maria Schubert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Quantile Regression ◽  
Correlation Coefficient ◽  
Odds Ratio ◽  
Strong Predictor ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Factors Associated

Background and Purpose: Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD). Methods: This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD. Results: The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P <0.001), 52% male (115/221) versus 62% non-PSD (214/346) and hospitalized longer (mean 11.5 versus 9.3 days; P <0.001). Dementia was the most relevant predisposing factor for PSD (odds ratio, 16.02 [2.83–90.69], P =0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16–20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15–159.79], P <0.001). PSD was a strong predictor for 3-month mortality (odds ratio, 15.11 [3.33–68.53], P <0.001). Nursing and total costs were nearly twice as high in PSD ( P <0.001). There was a positive correlation between total costs and admission National Institutes of Health Stroke Scale (correlation coefficient, 0.491; P <0.001) and length of stay (correlation coefficient, 0.787; P <0.001) in all patients. Quantile regression revealed rising nursing and total costs associated with PSD, higher National Institutes of Health Stroke Scale, and longer hospital stay (all P <0.05). Conclusions: PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.

scholarly journals Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
George Ntaios ◽  
Patrik Michel ◽  
Georgios Georgiopoulos ◽  
Yutao Guo ◽  
Wencheng Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Case Series ◽  
Severe Disability ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Patient Pathways

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]), P =0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4], P <0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

Abstract WP9: Primary Aspiration Thrombectomy in Acute Ischemic Stroke: A Single-Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Lana J Stein ◽  
Sandra K Hanson ◽  
Jeffrey P Lassig
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Single Center ◽  
Aspiration Thrombectomy ◽  
Discharge Disposition ◽  
Single Center Experience ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stent Retrievers

Background: Recent endovascular stroke studies utilizing primarily stent retrievers have proven clinical benefit among eligible patients. It remains unclear if this benefit is exclusive to stent retrievers. We present the results of a single-center experience for patients undergoing primary aspiration thrombectomy for acute ischemic stroke (AIS). Methods: A retrospective analysis of all AIS patients receiving primary aspiration thrombectomy from January 2014 to March 2016 was performed. We assessed stroke severity at admission and discharge as defined by the National Institutes of Health Stroke Scale score (NIHSSS), median onset to puncture and onset to recanalization times, location of target vessel treated, rate of concurrent intravenous (IV) alteplase use, and rate of TICI 2b/3 reperfusion. Outcomes adjudicated included rates of symptomatic intracerebral hemorrhage (sICH), favorable discharge disposition to home, and 90-day modified Rankin Scale (mRS) score ≤2. Results: During the study period, 121 patients (mean age 68.7±16.5 years, 53.7% women) received primary aspiration thrombectomy for 124 occlusions (26% terminal internal carotid artery, 45% M1, 15% M2, 11% basilar artery, 3% other). Median admission NIHSSS was 19 [11, 22] and improved to 6 [1, 15] upon discharge. Median onset to puncture and onset to recanalization times were 258 [148, 371] and 300 [180, 409] minutes, respectively. The rate of TICI 2b/3 reperfusion was 84.7%, and 52% received adjunctive IV alteplase. Rates of favorable discharge to home was 28.9% and 90-day mRS ≤2 was 39.8%. Only one patient developed sICH. Conclusion: Our single-center experience shows that primary aspiration thrombectomy can yield both favorable angiographic and clinical outcomes with minimal adverse effect.

Abstract TMP63: Accuracy of Remote Video Cellphone Evaluation of Stroke Deficits Using California Brief Stroke Scale

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Latisha K Ali ◽  
Sidney Starkman ◽  
Gilda Avila ◽  
Neal M Rao ◽  
Rana Fiaz ◽  
...  
Keyword(s):  
Stroke Care ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Stroke Severity ◽  
Strongly Correlated ◽  
Mobile Video ◽  
Substantial Agreement ◽  
Stroke Patients ◽  
Item Scale ◽  
Score Evaluation

Background: Availability of 4G cellular network and video cellphone handsets may allow mobile videophone assessment to be employed in prehospital stroke care. The California Brief Stroke Scale (CABSS) is a 4 item scale designed as a mobile videophone test to evaluate a prehospital telemedicine instrument to rate stroke severity. Potential uses include identifying patients who are likely harboring persisting large vessel occlusions and to characterize baseline deficits prior to enrollment in prehospital trials. Methods: One bedside and one remote CABSS score were independently obtained on 15 ischemic stroke patients with persistent neurologic deficits. The bedside examination was performed by a stroke neurologist. The remote examination was performed by a second stroke neurologist through mobile video phone. A CABSS score of 1 or higher (scale 0-7) was an index of global stroke deficit severity. Kappa coefficients were calculated for concordance between bedside and remote scores. Results: The median National Institutes of Health Stroke Scale score was 6 (interquartile range IQR 4-10). On average the CABSS score evaluation took 25 seconds to perform. The median video CABSS was 2, (IQR1-3) and median bedside CABSS was 3, (IQR 1-3). Based on weighted K coefficients, cortical findings (aphasia, gaze deviation/hemineglect) displayed excellent agreement κ=1 (95% CI 1.0) and non-cortical findings (facial droop, arm drift) displayed substantial agreement κ =0.7 (95% CI 0.4-1.0). There was substantial agreement between bedside and remote methods for the total CABSS κ 0.68 (95% CI 0.44-0.92). The CABSS scores obtained by bedside and remote methods were strongly correlated (r= 0.85, P<0.0001). Conclusion: Our prospective study found that mobile videocell phone evaluation using CABSS is a feasible and reliable means of examining hyperacute stroke patients in the field. A physician can rapidly perform an audiovideo examination to increase the accuracy of prehospital identification of patients harboring persisting large vessel occlusions and characterize baseline deficits prior to enrollment in prehospital clinical trials to a clinically important degree.

Sign in / Sign up

Export Citation Format

Share Document