Stroke; a journal of cerebral circulation
-
Pediatric acute stroke teams are a new phenomenon. We sought to characterize the final diagnoses of children with brain attacks in the emergency department where the pediatric acute stroke protocol was activated and to describe the time to neurological evaluation and neuroimaging. ⋯ Of pediatric brain attacks, 24% were stroke, 2% were transient ischemic attack, and 14% were other neurological emergencies. Together, 40% had a stroke or other neurological emergency, underscoring the need for prompt evaluation and management of children with brain attacks.
-
Comparative Study
Effect Size Estimates for the ESCAPE Trial: Proportional Odds Regression Versus Other Statistical Methods.
Ordinal outcomes, such as modified Rankin Scale (mRS), are the standard primary end points in acute stroke trials. Regression models for assessing treatment efficacy after adjusting for baseline covariates have been developed for continuous, binary, or ordinal end points. There has been no consensus on the best choice of method for analyzing these data. ⋯ The mRS distribution for both treatment and control groups influences the power of the investigated statistical models to assess treatment efficacy. A careful evaluation of the expected outcome distribution across the mRS scale is required to determine the best choice of primary analysis.
-
The National Institutes of Health Stroke Scale (NIHSS) provides a reliable, quantitative measure of ischemic stroke severity and is predicted by the infarct size. We sought to determine whether leukoaraiosis severity affects the association between infarct size and NIHSS. ⋯ Leukoaraiosis significantly modulates the association between infarct volume and NIHSS. The clinical implications of these findings need further exploration in prospective studies but may be relevant to mitigate outcome differences in patients with stroke by aiding treatment decisions that rely on the NIHSS.
-
Randomized Controlled Trial Multicenter Study
The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage.
Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI. ⋯ The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.
-
The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. ⋯ Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted. These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.