Portal de Periódicos da CAPES

Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke

2021; Lippincott Williams & Wilkins; Volume: 53; Issue: 2 Linguagem: Inglês

10.1161/strokeaha.121.034124

1524-4628

José G. Romano, Hannah Gardener, Eric E. Smith, Iszet Campo‐Bustillo, Yosef Khan, Sofie Tai, Nikesha Riley, Ralph L. Sacco, Pooja Khatri, Heather M. Alger, Brian Mac Grory, Deepak Gulati, Navdeep Sangha, Karin Olds, Curtis Benesch, Adam G. Kelly, Scott S Brehaut, Amit Kansara, Lee H. Schwamm, Scott Moody, Weiping Ye, Vena Sobhawongse, Jeffrey M. Craig, Heloisa Pearson, Deborah Summers, Christine Boerman, Christy Rice, Robin Kintner, Mayumi Oka, Sarah Baran, Christina Roels, Maureen Dosunmu, Cherylee W. J. Chang, Jennifer L. Moran, Denise Ditrich, Nicholas Lanciano, Aimee Mann, C. Romero, B L Thiele, David Salvatore, Annette Kujawski Taylor, Neel Shah, Rodney Leacock, A. Rochester, Fanny Guillerminet, Jerry C. Martin, Johnny Jones, Nicol Brandon, Vikas Grover, Maryika Gibson, Maheen Malik, C. Crawford Mechem, W. R. Logan, Camilla Cook, Muhib Khan, Christa Rood, Arun Babu, Leah Steinig, Jestin N. Carlson, Mélanie Henderson, Gabriel Vidal, Bethany Jennings, Jennifer A. Lynch, Jessica Ratcliff, Kathryn Kirchoff, Khadean Moncrieffe, Jennifer Rasmussen-Winkler, Leigh Allen, G.E. Thompson, Christopher Firek, Stephen Martino, Baher Georgy, Gillian Gordon Perue, Nina Vekima, Kasey Gildersleeve, Marian Skewes, Christina Valdovinos, Timothy C. Parsons, Cynthia Marques, John W. Chen, David Lombardi, Brenda Perez, Amer Malik, Kathy Hesse, Amy Guzik, Sandra E. Norona, Robert Hoesch, Jacki Anderson, Dorothea Altschul, Farah Fermin, Miran Salgado, Jonathan Muller, Indrani Acosta, Brooke Hartwell, Terry A. Neill, Carrie Hundley, Abhineet Chowdhary, Tina Fortney, José R. Romero, Brandon Finn, Refat Assad, Maggie Ellithorpe, Rebecca Sugg, Susan Hetzel, Muhammad M. Alvi, Jay Sherman, Jonathan Hartman, Tashia Orr, Ankur Garg, Melissa Turner, Curtis A. Given, Sara Renfrow, Jeffrey Hilburn, Ellen Looney, Christopher Commichau, Paul Jarvis, Changsoo Hahm, Melissa Mccaulley, Angel Pulido, Sergio Michel, Nima Ramezan‐Arab, Françoise Toussaint- Jones, Anna Khanna, Esther Olasoji, Armistead Williams, Elizabeth Purrington, R. Nagaraja Reddy, Renee Potter, Bhupat Desai, Karen Tse-Chang, Laurence Ufford, Leslie Drager, Keith O. Jones, Teresa Ellebusch, Stephen Martino, Michelle Dobrzynski, Elizabeth H. Wise, Ann Jerde, Gauhar Chaudhary, Robyn McLean, Joseph Hanna, Dana P. Cook, Franklin A. Marden, Jennifer Orde, Ajay Arora, Shawna Miller, Raymond Reichwein, Deborah Hoffman, Kelly Matmati, Nabil Matmati, Kumiko Owada, Laura Murphy, Ashish Masih, Bethany Fife, Larry Shepherd, H C G Matthew, Stephen T. Gancher, Sabrina Enoch, Matthew Smith, Denise Goings, Joseph Mazzola, Edward Plyler, Lisa Landers, James Napier, Laura Thoreson, Amer Alshekhlee, Michelle Raymond, Tarakad S. Ramachandran, Michael R. Jorolemon, David J Padalino, Collin Maloney, J Mott, Laxmi Dhakal, Cindy Murphy, Truman J. Milling, Patrick Lawrence, Harish Shownkeen, Kathy Hansen, Paul A. Cullis, Lynne Froehlich, Sajjad Mueed, Ryan Pavolka, Steven R. Levine, Nadege Gilles, Truman J. Milling, Laura LaChance, K C Nayyar, Karen Klein, Rose Dotson, Kristopher Rowe, Elisheva Coleman, Emily Sayles, Rajan Gadhia, Jason Lee, Paul W. Lewis, Jenny Nunley, Rehan Sajjad, C. Halliday, Angelos Katramados, Theresa Holmes, Rashmikant Kothari, Linda C. Mader, Fen Lei Chang, Kelly Western, Kinjal Desai, Colleen Kehr, Gary Reese, Ashu Jadhav, M Steinbach, Jeffrey L. Saver, Gilda Avila, Janice A. Miller, Alicia Gneiting, Matthew Tenser, Sarah E. Burke,

Venous Thromboembolism Diagnosis and Management

Clinical fluctuations in ischemic stroke symptoms are common, but fluctuations before hospital arrival have not been previously characterized.A standardized qualitative assessment of fluctuations before hospital arrival was obtained in an observational study that enrolled patients with mild ischemic stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) present on arrival to hospital within 4.5 hours of onset, in a subset of 100 hospitals participating in the Get With The Guidelines-Stroke quality improvement program. The number of fluctuations, direction, and the overall improvement or worsening was recorded based on reports from the patient, family, or paramedics. Baseline NIHSS on arrival and at 72 hours (or discharge if before) and final diagnosis and stroke subtype were collected. Outcomes at 90 days included the modified Rankin Scale, Barthel Index, Stroke Impact Scale 16, and European Quality of Life. Prehospital fluctuations were examined in relation to hospital NIHSS change (admission to 72 hours or discharge) and 90-day outcomes.Among 1588 participants, prehospital fluctuations, consisting of improvement, worsening, or both were observed in 35.5%: 25.1% improved once, 5.3% worsened once, and 5.1% had more than 1 fluctuation. Those who improved were less likely and those who worsened were more likely to receive alteplase. Those who improved before hospital arrival had lower change in the hospital NIHSS than those who did not fluctuate. Better adjusted 90-day outcomes were noted in those with prehospital improvement compared to those without any fluctuations.Fluctuations in neurological symptoms and signs are common in the prehospital setting. Prehospital improvement was associated with better 90-day outcomes, controlling for admission NIHSS and alteplase treatment. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02072681.