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.