• Morgan E McKeown, Ayush Prasad, Jessica Kobsa, Ilayda Top, Samuel B Snider, Chelsea Kidwell, CampbellBruce C VBCVDepartment of Medicine and Neurology, Melbourne Brain Center at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia., Stephen M Davis, Geoffrey A Donnan, Michael Lev, Kevin N Sheth, Nils Petersen, W Taylor Kimberly, and Matthew B Bevers.
• Division of Neurocritical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
• Neurocrit Care. 2022 Feb 1; 36 (1): 465146-51.

BackgroundCerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acute stroke.MethodsPatient-level data from six acute stroke clinical trials were combined with endovascular thrombectomy registries from two academic referral centers, generating a combined cohort of 1977 patients. MLS was extracted from the original trial data or measured on computed tomography or magnetic resonance imaging that was obtained a median of 47.0 h (interquartile range 27.0-75.1 h) after stroke onset. Logistic regression was performed to identify predictors of poor outcome and the minimal clinically relevant MLS threshold.ResultsThe presence of MLS was a predictor of poor outcome, independent of baseline clinical and demographic factors (adjusted odds ratio 4.46, 95% confidence interval 3.56-5.59, p < 0.001). Examining the full range of MLS values identified, a value of greater than 3 mm was the critical threshold that significantly predicted poor outcome (adjusted odds ratio 3.20 [1.31-7.82], p = 0.011).ConclusionsThese results show that the presence of MLS predicts poor outcome and, specifically, MLS value greater than 3 mm is an important threshold across a variety of clinical settings. These findings may have relevance for the design and interpretation of future trials for antiedema therapies.© 2021. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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