Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies
Background, Objective: At least 70% of all stroke patients are ineligible for recanalization therapy. We identified predictors of outcome among these patients, with special focus on notification of emergency medical services (EMS).Methods: We prospectively collected data of 250 consecutive patients...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-10-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.01060/full |
| _version_ | 1818984364847923200 |
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| author | Ágnes Mirolovics Ágnes Mirolovics Magdolna Bokor Balázs Dobi Judit Zsuga Dániel Bereczki Dániel Bereczki |
| author_facet | Ágnes Mirolovics Ágnes Mirolovics Magdolna Bokor Balázs Dobi Judit Zsuga Dániel Bereczki Dániel Bereczki |
| author_sort | Ágnes Mirolovics |
| collection | DOAJ |
| description | Background, Objective: At least 70% of all stroke patients are ineligible for recanalization therapy. We identified predictors of outcome among these patients, with special focus on notification of emergency medical services (EMS).Methods: We prospectively collected data of 250 consecutive patients with acute cerebrovascular diseases ineligible for recanalization therapy. Initial notification strategy and outcome were analyzed by regression models.Results: EMS notification rate was 55, 41, and 21% in patients with <6, 6–24, and >24 h stroke-to-door time. Atrial fibrillation (AF; OR = 2.66, 95% CI: 1.19–5.96), stroke severity (National Institutes of Health Stroke Scale score, NIHSS; OR = 1.12, 95% CI: 1.02–1.23), history of any psychiatric disease (OR = 2.2, 95% CI: 0.98–4.97), aphasia (OR = 1.99, 95% CI: 0.99–3.98), and residence type were predictors of EMS notification. Disability (modified Rankin Scale score [mRS]) both at discharge and at 1 year was associated with age, admission NIHSS score, type of cerebrovascular disorder, and pre-stroke mRS at discharge and discharge mRS at follow-up. Age (HR = 1.05, 95% CI: 1.02–1.08) and NIHSS (HR = 1.16, 95% CI: 1.12–1.21) had a significant effect on the relative hazard of death.Conclusions: EMS notification is influenced by AF, stroke severity, psychiatric disease, aphasia, and residence type. Early disability depends on age, the type and severity of the stroke, and pre-stroke mRS. Predictors of disability at 1 year after stroke are age, stoke severity, mRS at discharge, and recurrent ischemic stroke. Higher NIHSS and older age are associated with higher case fatality. In patients ineligible for recanalization, EMS notification had no significant effect on outcome, regarding both disability and survival. |
| first_indexed | 2024-12-20T18:17:50Z |
| format | Article |
| id | doaj.art-7ca5a2bada5149f284ef3b2f3f4e0ace |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-20T18:17:50Z |
| publishDate | 2019-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-7ca5a2bada5149f284ef3b2f3f4e0ace2022-12-21T19:30:20ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-10-011010.3389/fneur.2019.01060486789Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion TherapiesÁgnes Mirolovics0Ágnes Mirolovics1Magdolna Bokor2Balázs Dobi3Judit Zsuga4Dániel Bereczki5Dániel Bereczki6János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, HungaryDepartment of Neurology, National Institute of Psychiatry and Addictions Nyíro Gyula, Budapest, HungaryDepartment of Neurology, National Institute of Psychiatry and Addictions Nyíro Gyula, Budapest, HungaryDepartment of Probability Theory and Statistics, Eötvös Loránd University, Budapest, HungaryDepartment of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, HungaryDepartment of Neurology, Semmelweis University, Budapest, HungaryMTA-SE Neuroepidemiological Research Group, Budapest, HungaryBackground, Objective: At least 70% of all stroke patients are ineligible for recanalization therapy. We identified predictors of outcome among these patients, with special focus on notification of emergency medical services (EMS).Methods: We prospectively collected data of 250 consecutive patients with acute cerebrovascular diseases ineligible for recanalization therapy. Initial notification strategy and outcome were analyzed by regression models.Results: EMS notification rate was 55, 41, and 21% in patients with <6, 6–24, and >24 h stroke-to-door time. Atrial fibrillation (AF; OR = 2.66, 95% CI: 1.19–5.96), stroke severity (National Institutes of Health Stroke Scale score, NIHSS; OR = 1.12, 95% CI: 1.02–1.23), history of any psychiatric disease (OR = 2.2, 95% CI: 0.98–4.97), aphasia (OR = 1.99, 95% CI: 0.99–3.98), and residence type were predictors of EMS notification. Disability (modified Rankin Scale score [mRS]) both at discharge and at 1 year was associated with age, admission NIHSS score, type of cerebrovascular disorder, and pre-stroke mRS at discharge and discharge mRS at follow-up. Age (HR = 1.05, 95% CI: 1.02–1.08) and NIHSS (HR = 1.16, 95% CI: 1.12–1.21) had a significant effect on the relative hazard of death.Conclusions: EMS notification is influenced by AF, stroke severity, psychiatric disease, aphasia, and residence type. Early disability depends on age, the type and severity of the stroke, and pre-stroke mRS. Predictors of disability at 1 year after stroke are age, stoke severity, mRS at discharge, and recurrent ischemic stroke. Higher NIHSS and older age are associated with higher case fatality. In patients ineligible for recanalization, EMS notification had no significant effect on outcome, regarding both disability and survival.https://www.frontiersin.org/article/10.3389/fneur.2019.01060/fullstrokeemergency medical service notificationdisabilitysurvivallack of reperfusion |
| spellingShingle | Ágnes Mirolovics Ágnes Mirolovics Magdolna Bokor Balázs Dobi Judit Zsuga Dániel Bereczki Dániel Bereczki Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies Frontiers in Neurology stroke emergency medical service notification disability survival lack of reperfusion |
| title | Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies |
| title_full | Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies |
| title_fullStr | Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies |
| title_full_unstemmed | Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies |
| title_short | Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies |
| title_sort | notification strategy and predictors of outcome in stroke ineligible for reperfusion therapies |
| topic | stroke emergency medical service notification disability survival lack of reperfusion |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.01060/full |
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