So what EXACTLY are you doing to reduce those poor outcomes? Survivors don't care about predictions, they want RESULTS. WHEN THE HELL ARE YOU GOING TO GET THERE?
Cerebral Blood Flow Velocity Predicts Outcomes Following Subarachnoid Haemorrhage
By Nancy Melville
ORLANDO, Fla -- February 17, 2020 -- Elevations in cerebral blood flow velocity in the middle cerebral artery (MCA), as assessed with transcranial Doppler ultrasound, are associated with poor outcomes following subarachnoid haemorrhage, according to a study presented here at the 2020 Annual Meeting of the Society of Critical Care Medicine (SCCM).
“To our knowledge this is the first evidence that cerebrovascular velocities assessed through transcranial Doppler can be predictive of poor function and death after aneurysmal subarachnoid haemorrhage,” said Khalil Yousef, MD, University of Jordan, Amman, Jordan.
For the study, the researchers evaluated 505 patients with subarachnoid hemorrhage due to aneurysm rupture and Fisher grade>1. Among the patients, poor modified Rankin Scale scores (score, 4-6) were observed in 55% of patients at 3 months and in 23% at 12 months after discharge.Mortality rates were 10% before discharge, 15% at 3 months, and 17% at 12 months.
Among those with an elevation in MCA mean velocity, the mean amount of time from injury to the first elevation was 6.4 days from the left side MCA and 6.8 days for the right side. Patients with a MCA mean flow velocity >120 cm/s (vs < 120 cm/s) -- considered abnormally high -- were more than twice as likely to have poor MRS at discharge (odds ratio [OR] = 2.2; P< .001), and the odds were nearly as high at 3 months (OR = 2.1; P = .008) and 12 months (OR = 1.8; P = .038).
Higher mean MCA flow velocity was also associated with an increased likelihood of death at discharge (OR = 2.8; P = .005), at 3 months (OR = 2.2; P = .019), and at 12 months (OR = 1.9; P = .052).
“The magnitudes of association between MCA velocity and mortality and poor function at discharge were surprising,” said Dr. Yousef. “Patients who had mean MCA velocity >120 cm/s had approximately 3 times the odds of death and 2 times the odds of poor function at discharge compared with those with lower velocities.”
He noted the importance of being able to obtain the measures in a noninvasive manner.
“Our findings suggest that transcranial doppler can be very useful at the bedside,” said Dr. Yousef. “This can be even more important in patients with poor neurological exams in whom manifestations of clinical deterioration can’t be assessed.”
[Presentation title: Mean Flow Velocity of the Middle Cerebral Artery Predicts Poor Outcome After Subarachnoid Hemorrhage. Abstract 37]
ORLANDO, Fla -- February 17, 2020 -- Elevations in cerebral blood flow velocity in the middle cerebral artery (MCA), as assessed with transcranial Doppler ultrasound, are associated with poor outcomes following subarachnoid haemorrhage, according to a study presented here at the 2020 Annual Meeting of the Society of Critical Care Medicine (SCCM).
“To our knowledge this is the first evidence that cerebrovascular velocities assessed through transcranial Doppler can be predictive of poor function and death after aneurysmal subarachnoid haemorrhage,” said Khalil Yousef, MD, University of Jordan, Amman, Jordan.
For the study, the researchers evaluated 505 patients with subarachnoid hemorrhage due to aneurysm rupture and Fisher grade>1. Among the patients, poor modified Rankin Scale scores (score, 4-6) were observed in 55% of patients at 3 months and in 23% at 12 months after discharge.Mortality rates were 10% before discharge, 15% at 3 months, and 17% at 12 months.
Among those with an elevation in MCA mean velocity, the mean amount of time from injury to the first elevation was 6.4 days from the left side MCA and 6.8 days for the right side. Patients with a MCA mean flow velocity >120 cm/s (vs < 120 cm/s) -- considered abnormally high -- were more than twice as likely to have poor MRS at discharge (odds ratio [OR] = 2.2; P< .001), and the odds were nearly as high at 3 months (OR = 2.1; P = .008) and 12 months (OR = 1.8; P = .038).
Higher mean MCA flow velocity was also associated with an increased likelihood of death at discharge (OR = 2.8; P = .005), at 3 months (OR = 2.2; P = .019), and at 12 months (OR = 1.9; P = .052).
“The magnitudes of association between MCA velocity and mortality and poor function at discharge were surprising,” said Dr. Yousef. “Patients who had mean MCA velocity >120 cm/s had approximately 3 times the odds of death and 2 times the odds of poor function at discharge compared with those with lower velocities.”
He noted the importance of being able to obtain the measures in a noninvasive manner.
“Our findings suggest that transcranial doppler can be very useful at the bedside,” said Dr. Yousef. “This can be even more important in patients with poor neurological exams in whom manifestations of clinical deterioration can’t be assessed.”
[Presentation title: Mean Flow Velocity of the Middle Cerebral Artery Predicts Poor Outcome After Subarachnoid Hemorrhage. Abstract 37]
No comments:
Post a Comment