Deans' stroke musings: Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, October 23, 2019

Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies

Excuses, excuses, excuses. Damn it all, I want to know what the hell you are doing to get these ineligible patients 100% recovered. NOTHING? Then get the hell out of stroke and into an easier job, maybe basket making or watching paint dry.

Notification Strategy and Predictors of Outcome in Stroke Ineligible for Reperfusion Therapies

Ágnes Mirolovics^1,2,

Magdolna Bokor²,

Balázs Dobi³,

Judit Zsuga⁴ and

Dániel Bereczki^5,6^*

¹János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
²Department of Neurology, National Institute of Psychiatry and Addictions Nyíro Gyula, Budapest, Hungary
³Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
⁴Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
⁵Department of Neurology, Semmelweis University, Budapest, Hungary
⁶MTA-SE Neuroepidemiological Research Group, Budapest, Hungary

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="" 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.