Leaders would put into action the research needed to prevent early neurological deterioration. But you're not leaders; ARE YOU?
So you described a problem, offered no solution, didn't suggest further research; USELESS. And didn't even consider that early neurological deterioration might be caused by all the neurons dying because you've done nothing to stop the 5 causes of the neuronal cascade of death in the first days.
Early neurological deterioration in patients with acute ischemic stroke: a prospective multicenter cohort study
Abstract
Background:
There
is still no precise knowledge of the causes of progression in patients
with acute ischemic stroke (AIS), and we are unable to predict patients
at risk.
Objective:
To explore the frequency, predictive factors, and the prognosis of early neurological deterioration (END) in patients with AIS
Methods:
In
this prospective multicenter observational study, we assessed patients
with AIS admitted to 18 hospitals in Henan, China. We defined END as an
increase of ⩾2 points in total National Institutes of Health Stroke
Scale (NIHSS) score or ⩾1 point in the motor items of the NIHSS within
7 days after admission. Risk factors were analyzed using multivariate
logistic regression models. Prognosis was evaluated using the modified
Rankin Scale (mRS), with poor prognosis defined as mRS 3–6.
Results:
A
total of 9114 patients with AIS within 24 h of symptom onset were
enrolled in the study. END occurred in 1286 (14.1%) patients. The
highest incidence (62.5%) of END occurred within 24 h after admission.
After adjusting potential confounders, age, body mass index, waist–hip
ratio, systolic blood pressure, baseline NIHSS, disabled at baseline,
history of atrial fibrillation, diabetes mellitus, intracranial arterial
stenosis, infarct location in the lenticulostriate artery area and
cerebral watershed, neutrophils, lymphocytes, uric acid, and
triglycerides were identified as independent predictors for END. END was
significantly associated with poor prognosis at 90 days, and the
adjusted OR was 1.74 (95% CI: 1.53–1.97).
Conclusion:
One
in seven hospitalized patients with AIS may experience END within 24 h
of onset. The highest incidence of END occurred within 24 h of admission
and decreased steeply with time. Easily identifiable risk factors
predict END and could help understand the causal mechanisms and thereby
prevent END.
Introduction
Early
neurological deterioration (END) usually refers to the decline in
neurological function that occurs within a few hours or days of the
onset of acute ischemic stroke (AIS).1
Studies have reported END frequencies ranging from 5% to 40%, which
could have resulted from different evaluation methods and inclusion
criteria.2,3 Previous studies have indicated that END may affect the prognosis of patients with AIS.4
However, the etiology and pathogenesis of END in AIS are complex, and
clear descriptions, accurate and reliable early prediction indicators,
and effective prevention and treatment strategies are lacking.5 Therefore, it is important to explore END development in patients with AIS.
Although
previous studies have reported on AIS with END, most were retrospective
and focused on specific populations with stroke, such as patients
receiving intravenous thrombolysis and endovascular therapy or patients
with mild stroke.6–8
In addition, most studies were single-center, small-sample studies;
therefore, large multicenter prospective cohort data on END are lacking.
We aimed to improve END awareness by exploring the frequency, risk
factors, and functional outcomes in patients with AIS using multicenter
stroke registry data in Henan, China.
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