Braden Scale for Assessing Pneumonia After Acute Ischemic Stroke

Abstract Background Prevention of pneumonia is critical for patients with acute ischemic stroke (AIS). The six indexes in the Braden Scale seemsto be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of the Braden Scale in predicting the occurrence of pneumonia after AIS. Methods We studied a series of consecutive patients with AIS who were admitted to hospital. The cohort was subdivided into pneumonia group and no pneumonia group. The score of the Braden Scale, demographic and clinical characteristics at admission were obtained and analyzed by statistical comparisons between two groups. We investigated the predictive validity of the Braden scale by Receiver operating curve (ROC). Results 414 patients with AIS were included in this study. 57 of 414 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. The National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than in the no pneumonia group (P < 0.01). The mean score of the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group (P < 0.01). The six subscales of the Braden Scale between the two groups all had significant differences. The area under the curve (AUC) for the Braden scale predicting pneumonia after acute ischemic was 0.883 (95% CI = 0.828-0.937). And with 18 points as the demarcation score, the sensitivity was 83.2% and the specificity was 84.2%. Conclusion The Braden Scale with 18 points as the demarcation score is a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on effect of Braden Scale on stroke outcomes are needed.

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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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Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19

Narra J ◽

10.52225/narra.v1i3.50 ◽

2021 ◽

Vol 1 (3) ◽

Author(s):

Rizky Sarengat ◽

Mohammad S. Islam ◽

Mohammad S. Ardhi

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

National Institutes Of Health ◽

Neutrophil To Lymphocyte Ratio ◽

Stroke Patients ◽

Cross Sectional ◽

Lymphocyte Ratio ◽

Life Threatening ◽

The Mean

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

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Clot composition of embolic strokes of undetermined source: a feasibility study

BMC Neurology ◽

10.1186/s12883-020-01969-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Amre Nouh ◽

Tapan Mehta ◽

Mohamed Hussain ◽

Xianyuan Song ◽

Martin Ollenschleger

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

National Institutes Of Health ◽

Carotid Dissection ◽

Stroke Patients ◽

Stroke Etiology ◽

The Mean ◽

Undetermined Etiology ◽

A Prospective Study

Abstract Background A number of emerging studies have evaluated clot composition in acute ischemic stroke. Studies of clot composition of embolic strokes of undetermined strokes are lacking. Objectives We sought to analyze the RBC to platelet ratios in clots and correlated our findings with stroke etiology. Methods This was a prospective study analyzing clots retrieved by mechanical thrombectomy in acute ischemic stroke patients at our institution. All clots were stained and scanned at 200x magnification by using a Scanscope XT digital scanner (Apergio, Vista, California). Image-J software (National Institutes of Health, Bethesda, Maryland) was used for semi quantitative analysis of percentage RBC’s and platelets. Unpaired t-test was used to compare means of RBC to Platelet ratios. Correlation of RBC to Platelet ratios with stroke etiology was performed. Results A total of 33 clots from 33 patients were analyzed. Stroke etiology was undetermined in 6 patients, cardioembolic in 14, large vessel atherosclerosis (LVA) in 9, and carotid dissection in 4. The mean RBC to platelet ratio was 0.78:1 (+/− 0.65) in cardioembolic clots, 1.73:1 (+/− 2.38) in LVA and 1.4:1(+/− 0.70) in carotid dissections. Although patients with undetermined etiology had a similar clot composition to cardioembolic stroke (0.36:1+/− 0.33), (p = 0.19), it differed significantly from LVA and dissections respectively (p = 0.037, p = 0.01). Conclusion In our study, a low RBC to Platelet ratio was found among patients with embolic strokes of undetermined source, however shared similar characteristics with cardioembolic thrombi. Ongoing collection and analysis is needed to confirm these findings and its significance in evaluating stroke etiology.

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Circulating Circular RNAs as Biomarkers for the Diagnosis and Prediction of Outcomes in Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.027348 ◽

2020 ◽

Vol 51 (1) ◽

pp. 319-323 ◽

Cited By ~ 7

Author(s):

Lei Zuo ◽

Lin Zhang ◽

Juan Zu ◽

Zan Wang ◽

Bing Han ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Quantitative Polymerase Chain Reaction ◽

Area Under The Curve ◽

Circular Rna ◽

Population Based ◽

Circular Rnas ◽

Healthy Controls ◽

Change Rate ◽

Stroke Outcomes

Background and Purpose— Circular RNAs (CircRNAs) show promise as stroke biomarkers because of their participation in various pathophysiological processes associated with acute ischemic stroke (AIS) and stability in peripheral blood. Methods— A circRNA microarray was used to identify differentially expressed circulating circRNAs in a discovery cohort (3 versus 3). Validation (36 versus 36) and replication (200 versus 100) were performed in independent cohorts by quantitative polymerase chain reaction. Platelets, lymphocytes, and granulocytes were separated from blood to examine the origins of circRNAs. Results— There were 3 upregulated circRNAs in Chinese population–based AIS patients compared with healthy controls. The combination of 3 circRNAs resulted in an area under the curve of 0.875, corresponding to a specificity of 91% and a sensitivity of 71.5% in AIS diagnosis. Furthermore, the combination of change rate in 3 circRNAs within the first 7 days of treatment showed an area under the curve of 0.960 in predicting stroke outcome. There was significant increase in lymphocytes and granulocytes for circPDS5B (circular RNA PDS5B) and only in granulocytes for circCDC14A (circular RNA CDC14A) in AIS patients compared with healthy controls. Conclusions— Three circRNAs could serve as biomarkers for AIS diagnosis and prediction of stroke outcomes. The elevated levels of circPDS5B and circCDC14A after stroke might be because of increased levels in lymphocytes and granulocytes.

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BLOOD VISCOSITY AS A DETERMINING FACTOR OF ISCHEMIC STROKE OUTCOMES EVALUATED WITH NIHSS AND MRS ON DAY 7 AND 30 POST-THROMBOLYSIS

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2019v11i9.34820 ◽

2019 ◽

pp. 73-79

Author(s):

Al Rasyid ◽

Salim Harris ◽

Mohammad Kurniawan ◽

Taufik Mesiano ◽

Rakhmad Hidayat ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Viscosity ◽

Neurologic Deficit ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Stroke Outcomes ◽

Determining Factor

Objective: This study aimed to analyze blood viscosity as a determining factor of ischemic stroke outcomes evaluated with National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) on day 7 and 30 post-thrombolysis. Methods: This study was a 4-months cohort study taking place in Cipto Mangunkusumo General Hospital from January to April 2017. Subjects were collected at the Emergency Department or Neurology Outpatient Department. Eligible patients gave informed consent. Patients underwent numerous examinations, including blood viscosity test using digital microcapillary (DM) instrument. Outcomes of patients were identified on day 7 and day 30 post-thrombolysis using NIHSS and mRS, respectively. Results: Most acute ischemic stroke patients (88.6%) had blood hyperviscosity. 9.1% patients had poorer neurologic deficit on day 7 evaluated with NIHSS and 18.2% patients had poor outcome on day 30 evaluated with mRS. All patients with normal blood viscosity did not have a poorer neurologic deficit on day-7-evaluation. Conclusion: Blood viscosity determines the outcomes of acute ischemic stroke patients on day 7 and day 30 post-thrombolysis.

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Intra-arterial Thrombectomy with Stent Retriever for Acute Ischemic Stroke – a Retrospective, Single-centered Study from Brazil

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0037-1607062 ◽

2017 ◽

Vol 36 (04) ◽

pp. 213-216

Author(s):

Luana Gatto ◽

Viviane Zétola ◽

Zeferino Demartini Junior ◽

Fábio Nascimento ◽

Gelson Koppe

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mean Value ◽

Posterior Circulation ◽

Stent Retriever ◽

National Institutes Of Health ◽

Initial Experience ◽

Modified Rankin Scale ◽

Anterior Circulation ◽

The Mean

Objective To report our initial experience with intra-arterial thrombectomy (IAT) with stent retriever for acute ischemic stroke. Methods We conducted a retrospective review of patients with acute ischemic stroke who underwent IAT from September 2010 to August 2016. Results Forty-one patients were included; mean age was 57 years (range: 29–85), and 54% were women. There were 32 anterior circulation occlusions, and 11 posterior circulation occlusions. The mean value of the National Institutes of Health Stroke Scale (NIHSS) upon admission (available in 9/41 patients) was 14 (range: 6–20). Nineteen patients had favorable outcomes (modified Rankin Scale [mRS]: 0–2 at 6 months), and 22 had unfavorable outcomes (mRS: 3–6 at 6 months). The mortality rate was 37% (15/41). Favorable outcomes were associated with revascularization within the first 360 minutes of the onset of symptoms (p = 0.000001), and satisfactory revascularization (thrombolysis in cerebral infarction [TICI] scale: 2b or 3) (p = 0.0018). Conclusion It is of paramount importance to educate stroke teams on the benefits of IAT for acute ischemic stroke and the population on identifying stroke and seeking immediate care following symptom onset.

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Initial experience with the CatchView thrombectomy device for acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016784 ◽

2020 ◽

pp. neurintsurg-2020-016784

Author(s):

Murat Velioglu ◽

Yilmaz Onal ◽

Abdulbaki Agackiran ◽

Pelin Dogan Ak ◽

Hakki Muammer Karakas

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

National Institutes Of Health ◽

Initial Experience ◽

Nihss Score ◽

Intravenous Tissue Plasminogen Activator ◽

Thrombectomy Device ◽

The Mean ◽

Baseline Characteristics

BackgroundWe report our initial experience with the CatchView (CV) thrombectomy device in patients with acute ischemic stroke (AIS).MethodsA retrospective analysis of 53 of 284 AIS patients (mean age 66.6±14.8 years, range 37–94) treated with a CV device between January 2019 and February 2020 was performed. The baseline characteristics (gender, age, comorbidities, National Institutes of Health Stroke Scale (NIHSS) score, intravenous tissue plasminogen activator (IV-tPA) administration, and occlusion localization) of these subjects were recorded. Modified Thrombolysis in Cerebral Ischemia (mTICI) scores of 2b and 3 were considered to indicate successful recanalization, and subjects with a modified Rankin Scale score of ≤2 on day 90 was considered a good clinical outcomes.ResultsThe mean NIHSS score was 12.3±3. Successful recanalization was achieved in 45 subjects (84.90%), and the rate of good clinical outcomes on day 90 was 43.39%. The secondary distal embolus rate was 5.66%. Symptomatic hemorrhage was observed in 3.77% of the subjects, and the mortality rate was 13.2%.ConclusionsMechanical thrombectomy devices include a wide array of endovascular tools for removing clots in AIS patients. In terms of successful recanalization and good clinical outcomes on day 90, our initial experience with the CV devices was encouraging.

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Impact of off-hour endovascular therapy on outcomes for acute ischemic stroke: insights from STAR

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016474 ◽

2020 ◽

pp. neurintsurg-2020-016474

Author(s):

Christine Tschoe ◽

Carol Kittel ◽

Patrick Brown ◽

Muhammad Hafeez ◽

Peter Kan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

National Institutes Of Health ◽

Time Of Arrival ◽

Vessel Occlusion ◽

Shift Analysis ◽

Ordinal Logistic Regression Analysis ◽

The Mean ◽

Time Of Presentation

BackgroundThe off-hour effect has been observed in the medical care of acute ischemic stroke. However, it remains unclear if time of arrival affects revascularization rates and outcomes after endovascular therapy (EVT) for emergent large vessel occlusion (ELVO). We aimed to investigate the clinical outcomes of EVT between on-hour and off-hour admissions.MethodsPatients who underwent EVT for ELVO from January 2013 to June 2019 from the STAR Registry were included. Patients were grouped based on time of groin puncture: on-hour period (Monday through Friday, 7:00 am–4:59 pm) and off-hour period (overnight 5:00pm–6:59am and the weekends). Primary outcome was final modified Rankin Scale (mRS) at 90 days on mRS-shift analysis.ResultsA total of 1919 patients were included in the study from six centers. The majority of patients (1169, 60.9%) of patients presented during the off-hour period. The mean age was 68.1 years and 50.5% were women. Successful reperfusion, as defined by a Thrombolysis In Cerebral Infarction (TICI) score of ≥2B, was achieved in 88.8% in the on-hour group and 88.0% in the off-hour group. Good clinical outcome (mRS 0–2) was obtained in 34.4% of off-hour patients and 37.7% of on-hour patients. On multivariable ordinal logistic regression analysis, time of presentation was not associated with worsened outcome (OR 1.150; 95% CI 0.96 to 1.37; P=0.122). Age, admission National Institutes of Health Stroke Scale (NIHSS), baseline mRS, and final TICI score were significantly associated with worse outcomes.ConclusionThere is no statistical difference in functional outcome in acute ischemic stroke patients who underwent EVT during on-hours versus off-hours.

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Angioplasty of Intracranial Occlusion Resistant to Thrombolysis in Acute Ischemic Stroke

Neurosurgery ◽

10.1097/00006123-200106000-00019 ◽

2001 ◽

Vol 48 (6) ◽

pp. 1282-1290 ◽

Cited By ~ 14

Author(s):

Andrew J. Ringer ◽

Adnan I. Qureshi ◽

Richard D. Fessler ◽

Lee R. Guterman ◽

L. Nelson Hopkins

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Balloon Angioplasty ◽

Therapeutic Benefit ◽

National Institutes Of Health ◽

Arterial Infusion ◽

The Mean ◽

Distal Occlusion ◽

Arterial Thrombolysis

Abstract OBJECTIVE Thrombolysis has been demonstrated to improve revascularization and outcome in patients with acute ischemic stroke. Many centers now apply thrombolytic therapy locally via intra-arterial infusion. One therapeutic benefit is the ability to cross soft clots with a guidewire and to perform mechanical thrombolysis. In some instances, reopened arteries reocclude as a result of either thrombosis or vasospasm. We report the use of balloon angioplasty during thrombolysis for acute stroke. METHODS From June 1995 through June 1999, 49 patients underwent intra-arterial therapy for acute stroke. In this group, nine patients (seven men and two women) were treated with balloon angioplasty after inadequate recanalization with thrombolytic infusion. The mean age of these patients was 67.9 years. Nine matched control patients who underwent thrombolysis alone without angioplasty were chosen for comparison. RESULTS In the group of nine patients who had angioplasty, the mean National Institutes of Health Stroke Scale score at presentation was 21.8 ± 5.4. Four patients had residual distal occlusion after angioplasty, and one patient had a hemorrhagic conversion. Of the five patients in which recanalization was successful, none had reocclusion of the balloon-dilated vessel. The mean score at 30 days for the five survivors was 12.6 ± 14.9, for an improvement of 7.0 ± 14.2. Among the nine control patients, the mean score at presentation was 20.3 ± 5.2; the mean score at 30 days for the five survivors was 19.4 ± 7.7, for an improvement of 4.2 ± 7.8. CONCLUSION In our experience, balloon angioplasty is a safe, effective adjuvant therapy in patients who are resistant to intra-arterial thrombolysis. The use of balloon angioplasty may prevent reocclusion in a stenotic artery and permit distal infusion of thrombolytic agents.

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Braden Scale for Assessing Pneumonia After Acute Ischaemic Stroke

10.21203/rs.2.10382/v3 ◽

2019 ◽

Author(s):

Yunlong Ding ◽

Yazhou Yan ◽

Jiali Niu ◽

Yanrong Zhang ◽

Zhiqun Gu ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Area Under The Curve ◽

Cutoff Point ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Stroke Outcomes ◽

Braden Scale ◽

Grading Scale ◽

Gcs Score

Abstract Background The prevention of pneumonia is critical for patients with acute ischaemic stroke (AIS). The six subscales in the Braden Scale seem to be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of using the Braden Scale to predict the occurrence of pneumonia after AIS.Methods We studied a series of consecutive patients with AIS who were admitted to the hospital. The cohort was subdivided into pneumonia and no pneumonia groups. The scores on the Braden Scale, demographic characteristics and clinical characteristics were obtained and analysed by statistical comparisons between the two groups. We investigated the predictive validity of the Braden Scale by receiver operating characteristic (ROC) curve analysis.Results A total of 414 patients with AIS were included in this study. Of those 414 patients, 57 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. There were significant differences in age and histories of chronic obstructive pulmonary disease (COPD), dysphagia and Glasgow Coma Scale (GCS) score between the two groups, and the National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than that in the no pneumonia group ( P <0.01). The mean score on the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group ( P < 0.01). The six subscale scores on the Braden Scale were all significantly different between the two groups. The area under the curve (AUC) for the Braden Scale for the prediction of pneumonia after AIS was 0.883 (95% CI = 0.828-0.937). With 18 points as the cutoff point, the sensitivity was 83.2%, and the specificity was 84.2%.Conclusion The Braden Scale with 18 points as the cutoff point is likely a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on the association of the Braden Scale score with stroke outcomes are needed.

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