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1.
BMC Geriatr ; 21(1): 458, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372766

RESUMO

OBJECTIVES: This study aimed to construct and validate a prediction model of acute ischemic stroke in geriatric patients with primary hypertension. METHODS: This retrospective file review collected information on 1367 geriatric patients diagnosed with primary hypertension and with and without acute ischemic stroke between October 2018 and May 2020. The study cohort was randomly divided into a training set and a testing set at a ratio of 70 to 30%. A total of 15 clinical indicators were assessed using the chi-square test and then multivariable logistic regression analysis to develop the prediction model. We employed the area under the curve (AUC) and calibration curves to assess the performance of the model and a nomogram for visualization. Internal verification by bootstrap resampling (1000 times) and external verification with the independent testing set determined the accuracy of the model. Finally, this model was compared with four machine learning algorithms to identify the most effective method for predicting the risk of stroke. RESULTS: The prediction model identified six variables (smoking, alcohol abuse, blood pressure management, stroke history, diabetes, and carotid artery stenosis). The AUC was 0.736 in the training set and 0.730 and 0.725 after resampling and in the external verification, respectively. The calibration curve illustrated a close overlap between the predicted and actual diagnosis of stroke in both the training set and testing validation. The multivariable logistic regression analysis and support vector machine with radial basis function kernel were the best models with an AUC of 0.710. CONCLUSION: The prediction model using multiple logistic regression analysis has considerable accuracy and can be visualized in a nomogram, which is convenient for its clinical application.


Assuntos
Isquemia Encefálica , Hipertensão , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34310311

RESUMO

This study aimed to develop a sensitive index from transcranial Doppler (TCD) signals for quantitatively evaluating the effects of long-term external counterpulsation (ECP) treatment on stroke rehabilitation. We recruited 27 patients with unilateral ischemic stroke and a good acoustic window within 7 days of stroke onset. 15 of them received 35 daily 1-hour ECP treatment (ECP group) and the others underwent conventional therapy without ECP treatment (No-ECP group). We monitored blood flow in middle cerebral arteries on both sides by TCD, and analyzed them via discrete wavelet analysis method. The overall changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index were assessed. A 'big-wave' phenomenon was observed in TCD signals of patients in ECP group after 35 days' treatment, with significant fluctuation in frequency interval from 0.010 to 0.034 Hz as main feature. A new index, which was denoted as I , was derived from this phenomenon. The I was significantly higher for patients in ECP group than that for patients in No-ECP group after 35-days' treatment ( 0.01). And the I was positively correlated with NIHSS change in ECP group ( ). The new index could be used as an effective indicator for evaluating enhancement of endothelial metabolism and neurogenic activity after long-term ECP treatment.


Assuntos
Isquemia Encefálica , Contrapulsação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico , Circulação Cerebrovascular , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Ultrassonografia Doppler Transcraniana
3.
Ther Umsch ; 78(6): 313-319, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291659

RESUMO

Atrial fibrillation and ischaemic stroke: current treatment and personalized risk prediction of intracerebral haemorrhage Abstract. Atrial fibrillation is a major cause of stroke. Management of patients with atrial fibrillation and stroke is challenging. In this review article, based on the most recent scientific literature, the following questions are discussed: 1) When is the optimal point in time to start anticoagulation after a recent stroke? 2) How to treat patients with atrial fibrillation that have a stroke despite anticoagulant therapy? 3) What is the added value of MRI for personalized risk-prediction of intracerebral hemorrhage? 4) How to treat patients with atrial fibrillation after intracerebral hemorrhage? We provide recommendations for daily clinical management.


Assuntos
Fibrilação Atrial , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Isquemia Encefálica/diagnóstico , Hemorragia Cerebral , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle
4.
J Assoc Physicians India ; 69(1): 56-60, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34227777

RESUMO

Background and Objectives: Stroke is the second leading cause of death and third most common cause of disability-adjusted life years in the world. Atherosclerosis plays a key role in the pathogenesis of stroke and inflammation is central in the initiation, progression and complications of atherosclerosis by mediating every stage of atheroma development. High platelet counts may increase thrombocyte activation and aggravate the release of inflammatory mediators. In contrast, lymphocytes exert anti-inflammatory response in atherosclerosis development. The advantage of platelet to lymphocyte ratio (PLR) is that it reflects the condition of both inflammation and thrombosis pathways and is more valuable than either platelet or lymphocyte counts alone. This emerging marker has not been frequently studied with acute ischemic stroke; hence aim of the present study was to find out the role of PLR (Platelet to lymphocyte ratio) in patients of acute ischemic stroke and correlating with NIHSS for predicting the prognosis. Material and Methods: 100 cases of AIS and equal number of age and gender matched control were enrolled in the study. NIHSS score and PLR (from the CBC test) was calculated both at admission and on day 7 or discharge. Results: Maximum subjects in our study were in the age range of 61-70 years with males (69%) outnumbering females (31%). Incidence of hypertension, diabetes mellitus, hyperlipidemia, smoking and alcoholism was more in the cases than controls. Mean PLR was higher in the patients of AIS (235.98±93.92) as compared to control group (115.60±27.87) (p=0.0001). Moreover, there was statistically significant, positive correlation between PLR and NIHSS score both at admission and discharge. PLR value increased significantly from the baseline in patients who deteriorated (263.42±108.98 to 346.28±125.35; p=0.016), decreased drastically in patients who improved (242.27±75.14 to 167.19±57.91; p=0.0001) and did not change much in patients who tend to remain static (181.35±105.40 to 183.36±111.61; p=0.955). Conclusion: Platelet to lymphocyte ratio (PLR) is a simple, cost effective and easily obtainable novel inflammatory marker that may help in predicting the severity of disease and prognosis in terms of functional outcome as evidenced by its increased value in patients of acute ischemic stroke as well as its linear positive correlation with NIHSS score.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Plaquetas , Isquemia Encefálica/diagnóstico , Feminino , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico
5.
Ugeskr Laeger ; 183(24)2021 06 14.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34120686

RESUMO

Neurological sequelae occur in more than 50% of children with arterial ischemic stroke. Early recognition and treatment are essential in improving outcome. However, diagnostic delay in paediatric stroke often extends beyond 24 hours, and children rarely access hyperacute recanalisation therapies. This review describes clinical presentations, risk factors and treatment of paediatric ischaemic stroke. Additionally, we share our experience from a systematic paediatric stroke pathway implemented in Eastern Denmark since 2017.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Criança , Diagnóstico Tardio , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia
6.
BMC Neurol ; 21(1): 229, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34157993

RESUMO

BACKGROUND: Ischemic events are the most common postoperative complication in bypass surgery for moyamoya disease (MMD), but the risk factors for pediatric MMD remain unclear. The goal of the study was to investigate the risk factors for postoperative ischemic complications in pediatric MMD patients. METHODS: We retrospectively reviewed a consecutive series of pediatric MMD cases at Beijing Tiantan Hospital, Capital Medical University from June 2010 through June 2019. Preoperative clinical variables and radiographic findings were recorded, and logistic regression analysis was carried out to identify the risk factors for postoperative ischemic events. RESULTS: A total of 533 operations in 336 patients were included in this study. Postoperative complications occurred after 51 operations (9.6%), including 40/447 indirect bypass procedures, 9/70 direct bypass procedures, and 2/16 combined bypass procedures. Postoperative ischemic events were the most common complication and occurred in 30 patients after 31 procedures (8.9% per patient; 5.8% per operation), including 26/447 indirect bypass procedures, 4/70 direct bypass procedures, and 1/16 combined bypass procedures, and the incidence of these events did not differ significantly between indirect and non-indirect bypass (5.8% vs 5.8%; p = 0.999). Multivariate logistic regression analyses revealed that older age at operation (OR 1.129, 95% CI 1.011-1.260, p = 0.032) and posterior cerebral artery involvement (OR 2.587, 95% CI 1.030-6.496, p = 0.043) were significantly associated with postoperative ischemic events. CONCLUSION: We speculate that older age at operation and posterior cerebral artery involvement are risk factors for postoperative ischemic events in pediatric MMD patients.


Assuntos
Isquemia Encefálica/etiologia , Revascularização Cerebral/efeitos adversos , Doença de Moyamoya/cirurgia , Adolescente , Fatores Etários , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Modelos Logísticos , Angiografia por Ressonância Magnética , Masculino , Artéria Cerebral Posterior/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
7.
J Clin Neurosci ; 89: 56-64, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119295

RESUMO

BACKGROUND: Red blood cell distribution width to platelet ratio (RPR), Monocyte to high-density lipoprotein ratio (MHR), and Neutrophil to lymphocyte ratio (NLR) are novel inflammatory biomarkers in laboratory tests, which are associated with clinical outcomes in malignancy, cardiovascular and cerebrovascular diseases. This study aimed to determine their predictive value for the prognosis of acute ischemic stroke after mechanical thrombectomy (MT). METHODS: A total of 286 patients with acute ischemic stroke (AIS) admitted to a tertiary stroke center in China between January 2018 and February 2020 were treated by MT. Demographic characteristics, risk factors, clinical data, laboratory parameters, and clinical outcomes were recorded. The clinical outcome was disability or death at discharge or 90 days (defined as a modified Rankin Scale score of 3-6). The relationship between RPR, MHR, and NLR and functional outcomes was investigated by binary Logistic regression analysis, and further assessed by receiver operating characteristic curve (ROC). The Kaplan-Meier method was used to analyze the survival rate of prognosis factors. RESULTS: A total of 286 patients with AIS underwent MT (median age, 70.00; Interquartile range [IQR], 63.00-77.00; 41.6% female). Patients with unfavorable outcome showed higher RPR, MHR, and NLR than those with favorable outcome (RPR, [8.63; IQR, 6.30-10.78] vs [6.17; IQR, 5.11-7.35], P < 0.001; MHR, [0.40; IQR, 0.31-0.53] vs [0.34; IQR, 0.27-0.47], P = 0.005; NLR, [5.28; IQR, 3.63-8.02] vs [3.44; IQR, 2.63-4.63], P < 0.001). In multivariate and ROC curve analysis, higher RPR (>8.565) (odds ratio [OR], 1.671; 95% confidence interval [CI], 1.127-2.479; P = 0.011) and higher MHR (>0.368) (OR, 9.374; 95% CI, 1.160-75.767; P = 0.036), higher NLR (>4.030) (OR, 1.957; 95% CI, 1.382-2.770; P < 0.001) were independently associated with unfavorable outcome. The combined predictive value of the three indexes was higher than that of a single index. Kaplan-Meier survival curve analysis showed that the 90-day survival rate (82.1% vs 66.2%) was significantly different between the low RPR group and the high RPR group (χ2 = 4.960, P = 0.026). CONCLUSION: Higher RPR, MHR, and NLR might be independent risk factors for predicting 3-month poor prognosis in patients with AIS who underwent MT.


Assuntos
Isquemia Encefálica/sangue , Isquemia Encefálica/cirurgia , AVC Isquêmico/sangue , AVC Isquêmico/cirurgia , Leucócitos Mononucleares/metabolismo , Trombectomia/tendências , Idoso , Biomarcadores/sangue , Plaquetas/metabolismo , Isquemia Encefálica/diagnóstico , Feminino , Humanos , AVC Isquêmico/diagnóstico , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Neutrófilos/metabolismo , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
Int J Chron Obstruct Pulmon Dis ; 16: 1851-1862, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34168444

RESUMO

Purpose: To compare the incidence, clinical characteristics and outcomes of patients admitted with ischemic stroke (IS) according to the presence of COPD and sex in Spain (2016-2018). Patients and Methods: We selected all admissions with IS (≥35 years) included in the Spanish National Hospital Discharge Database. We matched each patient suffering COPD with a non-COPD patient with identical age, sex, IS type and year of hospitalization. Results: IS was coded in 92,524 men and 79,731 women (8.67% with COPD). The incidence of IS was higher in COPD men than in non-COPD men (IRR 1.04; 95% CI 1.03-1.06), although the differences were not significant among women. COPD men had twice higher incidence of IS than COPD women (IRR 2.00; 95% CI 1.93-2.07). After matching, COPD men had a higher in-hospital mortality (IHM) than non-COPD men (11.48% vs 9.80%; p<0.001), and the same happened among women (14.09% vs 11.96%; p=0.002). COPD men received thrombolytic therapy less frequently than non-COPD men. For men and women, the risk of dying in the hospital increased with age, some comorbidities and mechanical ventilation use. After multivariable adjustment, COPD increased the risk of IHM in men (OR 1.16; 95% CI 1.06-1.28) and women (OR 1.12; 95% CI 1.01-1.27). Finally, among COPD patients, being women increased the risk of dying during the hospitalization with IS by 15% (OR 1.15; 95% CI 1.03-1.28). Conclusion: Incidence of IS was higher in COPD patients, although the difference was only significant for men. COPD was associated with an increased risk of IHM. Among COPD patients, women had higher IHM.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Doença Pulmonar Obstrutiva Crônica , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Incidência , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Caracteres Sexuais , Espanha/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
11.
Rev Prat ; 71(1): 75-78, 2021 Jan.
Artigo em Francês | MEDLINE | ID: mdl-34160951

RESUMO

Arterial ischemic stroke in children Stroke in children is an event of sudden occurrence with severe impact on the child's life. Most children will have consequences, lasting all lifelong. Early recognition of first symptoms, most often unilateral sudden motor deficit, is crucial to launch a pediatric stroke alert. MRI is the first and only imaging modality in this setting. Written protocols of early management improve early management for all patients. Rapid management permits the opportunity to consider recanalization treatments (intravenous thrombolysis, endovascular thrombectomy) in selected patients. Follow-up must be prolonged, adjusted to the age of stroke occurrence and to the personal developmental trajectory. Not only motor and cognitive deficits are considered, but also social participation and the preparation of the child's adult life.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Criança , Humanos , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Trombectomia , Resultado do Tratamento
15.
BMC Geriatr ; 21(1): 330, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030636

RESUMO

BACKGROUND: Soluble suppression of tumorigenesis-2 (sST2) was reported to be associated with cognitive performance and risk of incident stroke. However, the impact of sST2 on cognitive function after ischemic stroke is unclear. We aimed to assess the association of sST2 and cognitive impairment at 3 months in acute ischemic stroke patients. METHODS: Baseline plasma sST2 levels were measured in 619 ischemic stroke patients (mean age: 60.0 ± 10.5 years) from 7 participating hospitals of the China Antihypertensive Trial in Acute Ischemic Stroke. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to assess cognitive status. Cognitive impairment was defined as a MoCA score < 23 or MMSE score < 27. The association between sST2 and cognitive impairment was evaluated by logistic regression analysis. RESULTS: 325 (52.5%) or 323 (52.2%) participants developed cognitive impairment according to MoCA or MMSE. After adjustment for age, sex, education, and other covariates, the odds ratio for the highest vs lowest quartile of sST2 was 2.38 (95% CI, 1.42-4.00) and 1.82 (95% CI 1.09-3.03) risk of cognitive impairment defined by MoCA and MMSE score, respectively. Incorporation sST2 into a model containing conventional risk factors significantly improved reclassification. CONCLUSIONS: Elevated plasma sST2 levels were significantly associated with post-stroke cognitive impairment.


Assuntos
Isquemia Encefálica , Disfunção Cognitiva , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , China/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Humanos , Proteína 1 Semelhante a Receptor de Interleucina-1 , Testes Neuropsicológicos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
16.
Lancet Neurol ; 20(6): 426-436, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34022169

RESUMO

BACKGROUND: Systematic electrocardiogram (ECG) monitoring improves detection of covert atrial fibrillation in stroke survivors but the effect on secondary prevention is unknown. We aimed to assess the effect of systematic ECG monitoring of patients in hospital on the rate of oral anticoagulant use after 12 months. METHODS: In this investigator-initiated, randomised, open-label, parallel-group multicentre study with masked endpoint adjudication, we recruited patients aged at least 18 years with acute ischaemic stroke or transient ischaemic attack without known atrial fibrillation in 38 certified stroke units in Germany. Patients were randomly assigned (1:1) to usual diagnostic procedures for atrial fibrillation detection (control group) or additional Holter-ECG recording for up to 7 days in hospital (intervention group). Patients were stratified by centre using a random permuted block design. The primary outcome was the proportion of patients on oral anticoagulants at 12 months after the index event in the intention-to-treat population. Secondary outcomes included the number of patients with newly diagnosed atrial fibrillation in hospital and the composite of recurrent stroke, major bleeding, myocardial infarction, or death after 6 months, 12 months, and 24 months. This trial was registered with ClinicalTrials.gov, NCT02204267, and is completed and closed for participants. FINDINGS: Between Dec 9, 2014, and Sept 11, 2017, 3465 patients were randomly assigned, 1735 (50·1%) to the intervention group and 1730 (49·9%) to the control group. Oral anticoagulation status was available in 2920 (84·3%) patients at 12 months (1484 [50·8%] in the intervention group and 1436 [49·2%] in the control group). For the primary outcome, at 12 months, 203 (13·7%) of 1484 patients in the intervention group versus 169 (11·8%) of 1436 in the control group were on oral anticoagulants (odds ratio [OR] 1·2 [95% CI 0·9-1·5]; p=0·13). Atrial fibrillation was newly detected in patients in hospital in 97 (5·8%) of 1714 in the intervention group versus 68 (4·0%) of 1717 in the control group (hazard ratio [HR] 1·4 [95% CI 1·0-2·0]; p=0·024). The composite of cardiovascular outcomes and death did not differ between patients randomly assigned to the intervention group versus the control group at 24 months (232 [13·5%] of 1714 vs 249 [14·5%] of 1717; HR 0·9 [0·8-1·1]; p=0·43). Skin reactions due to study ECG electrodes were reported in 56 (3·3%) patients in the intervention group. All-cause death occured in 73 (4·3%) patients in the intervention group and in 103 (6·0%) patients in the control group (OR 0·7 [0·5-0·9]). INTERPRETATION: Systematic core centrally reviewed ECG monitoring is feasible and increases the detection rate of atrial fibrillation in unselected patients hospitalised with acute ischaemic stroke or transient ischaemic attack, if added to usual diagnostic care in certified German stroke units. However, we found no effect of systematic ECG monitoring on the rate of oral anticoagulant use after 12 months and further efforts are needed to improve secondary stroke prevention. FUNDING: Bayer Vital. TRANSLATION: For the German translation of the abstract see Supplementary Materials section.


Assuntos
Fibrilação Atrial/fisiopatologia , Isquemia Encefálica/fisiopatologia , AVC Isquêmico/fisiopatologia , Monitorização Fisiológica/métodos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Eletrocardiografia/métodos , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
Best Pract Res Clin Anaesthesiol ; 35(2): 171-179, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34030802

RESUMO

Since 2015, endovascular thrombectomy has been established as the standard of care for re-establishing cerebral blood flow in patients with acute ischemic stroke. Several retrospective observational studies and prospective clinical trials have investigated two anesthetic techniques for endovascular stroke therapy: general anesthesia (GA) and conscious sedation (CS). The recent randomized studies suggest that GA is associated with higher rates of successful recanalization and better functional independence at 3 months compared with the CS technique. However, CS techniques are highly variable, and there is currently a lack of consensus on which anesthetic approach is best in all patients. Numerous patient and procedural factors should ultimately guide the decision of whether GA or CS should be used for a particular patient.


Assuntos
Anestesia Geral/métodos , Isquemia Encefálica/cirurgia , Sedação Consciente/métodos , Cuidados Intraoperatórios/métodos , AVC Isquêmico/cirurgia , Trombectomia/métodos , Anestesia Geral/efeitos adversos , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Sedação Consciente/efeitos adversos , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos
19.
Ideggyogy Sz ; 74(3-4): 99-103, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33938669

RESUMO

Background and purpose: Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. Methods: We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Results: Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Conclusion: Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.


Assuntos
Isquemia Encefálica , Serviços Médicos de Emergência , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Estudos Transversais , Humanos , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico
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