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Utility of items of baseline NIH stroke scale as predictors of functional outcomes 3 months after mild ischemic stroke
ORAL SESSION
888
【Interpretation】Alteplase treatment within 6 h after ischaemic stroke led to a small, non-significant reduction in risk of death at 3 years, but among individuals who survived to 7 days, treatment was associated with a significant increase in long-term survival.
O2-1-6 Utility of items of baseline NIH stroke scale as predictors of functional outcomes 3 months after mild ischemic stroke Jay Chol Choi
O2-1-5 Feasibility of using magnetic resonance imaging as a screening tool for acute stroke thrombolysis
Department of Neurology, Jeju National
University, Republic of Korea.
Jun Lee,1 Jae-Kwan Cha,2 Joon-Tae Kim,3 and Hee-Joon Bae4 1
Department of Neurological Science, Nippon Medical School, Japan
Department of Neurology, Yeungnam University Hospital, Republic of Korea; 2 Department of Neurology, Dong-A University College of Medicine, Republic of Korea; 3 Department of Neurology, Chonnam National University Hospital, Republic of Korea 4 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
【Background】Feasibility of performing MRI first for suspected hyperacute stroke patients in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-needle time (DNT) in intravenous thrombolysis were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and examine the effects of a quality improvement (QI) process for reducing DNT using MRI. 【Methods】From January 2014 to August 2015, consecutive acute stroke patients who were treated with thrombolysis were prospectively enrolled into the present study. In principle, multimodal 1.5T-MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DNT, including prenotification by the emergency medical service, limiting the MRI sequence, and introduction of a rapid examination tool, was also implemented during this period. Time metrics for thrombolysis were compared between specific time periods. 【Results】A total of 73 patients (27 women; median age 74 years) were included in the present study. More than 80% of the patients were screened with MRI. More patients were managed with the MRI-first policy in the late phase (P = .018). DNT (83 min in the early phase, 68 min in the middle phase, and 54 min in the late phase, P < .001) was significantly reduced across phases. The percentage of patients with DNT <60 min increased significantly across time periods (P < .001). 【Conclusion】An MRI-first policy was feasible, and DNT was substantially reduced with a QI process. This process may be applicable to other hospitals.
【Background and Purpose】Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision-making regarding thrombolytic therapy. We examined the utility of individual NIH Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes 3 months after mild stroke. 【Methods】Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial NIHSS scores ≤5. Functional outcomes at 3 months were dichotomized as favorable (modified Rankin Scale [mRS] score zero or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the ROC curve (AUC) was used to assess model performance. 【Results】Of the 2209 patients who met eligibility criteria, 588 patients (26.6%) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all items except for items 8 (sensory) and 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P’s < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95% confidence interval, .739-.775] vs. .759 [.740-.776]; P = .75 for pairwise comparison). 【Conclusions】Simply using the total score was as effective as using all NIHSS items or clinical stroke syndromes in predicting outcomes of mild stroke patients.
Yuki Sakamoto
Department of Neurological Science, Nippon
Medical School, Japan.
Seiji Okubo, Satoshi Suda, Arata Abe, Junya Aoki, Kanako Muraga, Takuya Kanamaru, Kentaro Suzuki, and Kazumi Kimura
888
【Interpretation】Alteplase treatment within 6 h after ischaemic stroke led to a small, non-significant reduction in risk of death at 3 years, but among individuals who survived to 7 days, treatment was associated with a significant increase in long-term survival.
O2-1-6 Utility of items of baseline NIH stroke scale as predictors of functional outcomes 3 months after mild ischemic stroke Jay Chol Choi
O2-1-5 Feasibility of using magnetic resonance imaging as a screening tool for acute stroke thrombolysis
Department of Neurology, Jeju National
University, Republic of Korea.
Jun Lee,1 Jae-Kwan Cha,2 Joon-Tae Kim,3 and Hee-Joon Bae4 1
Department of Neurological Science, Nippon Medical School, Japan
Department of Neurology, Yeungnam University Hospital, Republic of Korea; 2 Department of Neurology, Dong-A University College of Medicine, Republic of Korea; 3 Department of Neurology, Chonnam National University Hospital, Republic of Korea 4 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
【Background】Feasibility of performing MRI first for suspected hyperacute stroke patients in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-needle time (DNT) in intravenous thrombolysis were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and examine the effects of a quality improvement (QI) process for reducing DNT using MRI. 【Methods】From January 2014 to August 2015, consecutive acute stroke patients who were treated with thrombolysis were prospectively enrolled into the present study. In principle, multimodal 1.5T-MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DNT, including prenotification by the emergency medical service, limiting the MRI sequence, and introduction of a rapid examination tool, was also implemented during this period. Time metrics for thrombolysis were compared between specific time periods. 【Results】A total of 73 patients (27 women; median age 74 years) were included in the present study. More than 80% of the patients were screened with MRI. More patients were managed with the MRI-first policy in the late phase (P = .018). DNT (83 min in the early phase, 68 min in the middle phase, and 54 min in the late phase, P < .001) was significantly reduced across phases. The percentage of patients with DNT <60 min increased significantly across time periods (P < .001). 【Conclusion】An MRI-first policy was feasible, and DNT was substantially reduced with a QI process. This process may be applicable to other hospitals.
【Background and Purpose】Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision-making regarding thrombolytic therapy. We examined the utility of individual NIH Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes 3 months after mild stroke. 【Methods】Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial NIHSS scores ≤5. Functional outcomes at 3 months were dichotomized as favorable (modified Rankin Scale [mRS] score zero or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the ROC curve (AUC) was used to assess model performance. 【Results】Of the 2209 patients who met eligibility criteria, 588 patients (26.6%) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all items except for items 8 (sensory) and 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P’s < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95% confidence interval, .739-.775] vs. .759 [.740-.776]; P = .75 for pairwise comparison). 【Conclusions】Simply using the total score was as effective as using all NIHSS items or clinical stroke syndromes in predicting outcomes of mild stroke patients.
Yuki Sakamoto
Department of Neurological Science, Nippon
Medical School, Japan.
Seiji Okubo, Satoshi Suda, Arata Abe, Junya Aoki, Kanako Muraga, Takuya Kanamaru, Kentaro Suzuki, and Kazumi Kimura