Stroke; a journal of cerebral circulation
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To date, no validated, comprehensive, and practicable model exists to predict functional recovery within the first hours of cerebral ischemic symptoms. The purpose of this study was to externally validate 2 prognostic models predicting functional outcome and survival at 100 days within the first 6 hours after onset of acute cerebral ischemia. ⋯ The resulting prognostic models are useful to correctly stratify treatment groups in clinical trials and should guide inclusion criteria in clinical trials, which in turn increases the power to detect clinically relevant differences.
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This study describes several quality indicators of care in hospitalized stroke patients in Michigan from 1998 to 1999. ⋯ Timing for brain imaging and acute ischemic stroke symptom onset need to be better documented, along with more provider education for routine deep venous thrombosis prophylaxis.
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Several studies established smoking as a risk factor for ischemic stroke and subarachnoid hemorrhage (SAH) in men and women. A recent study added smoking as a risk factor for intracerebral hemorrhage (ICH) in men. In contrast, the impact of smoking on ICH in women is less clear. ⋯ This prospective study indicates an increased risk of total hemorrhagic stroke, ICH, and SAH in women who are current cigarette smokers. The risk increases with the amount of cigarettes smoked.
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Clinical Trial
Telemedicine in emergency evaluation of acute stroke: interrater agreement in remote video examination with a novel multimedia system.
In acute stroke care, rapid but careful evaluation of patients is mandatory but requires an experienced stroke neurologist. Telemedicine offers the possibility of bringing such expertise quickly to more patients. This study tested for the first time whether remote video examination is feasible and reliable when applied in emergency stroke care using the National Institutes of Health Stroke Scale (NIHSS). ⋯ Remote examination of acute stroke patients with a computer-based telesupport system is feasible and reliable when applied in the emergency room; interrater agreement was good to excellent in all items. For more widespread use, some problems that emerge from details like brightness, optimal camera position, and audio quality should be solved.
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Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management. ⋯ Teleconsultation using a videoconference system seems to be a feasible and promising method to improve stroke care in rural areas where management in a stroke unit is hindered by long transportation distances.