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The influence of initial stroke severity on mortality, overall functional outcome and in-hospital placement at 90 days following acute ischemic stroke: A tertiary hospital stroke register study

Artikel i vetenskaplig tidskrift
Författare S. Bhaskar
P. Stanwell
A. Bivard
N. Spratt
R. Walker
G. H. Kitsos
M. W. Parsons
M. Evans
L. Jordan
Michael Nilsson
J. Attia
C. Levi
Publicerad i Neurology India
Volym 65
Nummer/häfte 6
Sidor 1252-1259
ISSN 0028-3886
Publiceringsår 2017
Publicerad vid Institutionen för neurovetenskap och fysiologi
Sidor 1252-1259
Språk en
Länkar doi.org/10.4103/0028-3886.217947
Ämnesord Age, hospital assessment, mortality, NIHSS, prognosis, stroke, stroke severity, intensive-care-unit, scale score, plasminogen-activator, external, validation, performance reports, adjusted mortality, copenhagen stroke, prognostic models, risk adjustment, short-term, Neurosciences & Neurology
Ämneskategorier Neurovetenskaper

Sammanfattning

Background and Purpose: Epidemiological studies on the extent of the interaction and/or influence of stroke severity on clinical outcomes are important. The aim of the present study was to investigate the putative (and degree of) impact of initial stroke severity in predicting the overall functional outcome, in-hospital placement, and mortality in acute ischemic stroke (AIS) in comparison with age, admission to the stroke unit and thrombolytic treatment. Materials and Methods: The John Hunter Hospital acute stroke register was used to collect a retrospective cohort of AIS patients being assessed for reperfusion therapy and admitted between January 2006 and December 2013. Univariate and multivariate logistic regression and receiver operating characteristics analyses were used to assess associations with functional outcome, in-hospital placement, and mortality at 90 days. Results: 608 AIS patients with complete datasets were included in the study. On univariate analysis, initial stroke severity showed the strongest independent association to the risk of death within 90 days (Odds ratio (OR) = 1.15; P < 0.001; 95% confidence interval (CI) = [1.11, 1.18]); age was a less significant independent influence (OR = 1.02; P = 0.049; 95% CI = [1.00, 1.03]). Multivariate logistic regression analysis demonstrated that initial stroke severity independently predicted the 90 day mortality (OR = 1.16; 95% CI = [1.12, 1.2]; P < 0.0001) and unfavorable outcome (OR = 1.16; 95% CI = [1.13, 1.2]; P < 0.0001). Higher National Institute of Health Stroke Scale at admission was significantly associated with longer in-hospital placement (P < 0.0001). Conclusions: In this acute stroke cohort, initial stroke severity had a major impact on the likelihood of death following an AIS and appears to be the dominant influence on the overall stroke outcome and in-hospital placement.

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