Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS

 What the fuck good does prediction of non-recovery do? Do you tell your patients you have nothing that will get them 100% recovered? Or will you be like my doctor and know nothing and do nothing about stroke? And why are you talking about symptoms rather than an objective diagnosis? Symptoms can occur from multiple possibilities; see below:

See this example of nine reasons for a movement disability:

 

You can't tell me these all have the same solution, I'm not that stupid.
1. Penumbra damage to the motor cortex.
2. Dead brain in the motor cortex.
3. Penumbra damage in the pre-motor cortex.
4. Dead brain in the pre-motor cortex.
5. Penumbra damage in the executive control area.
6. Dead brain in the executive control area.
7. Penumbra damage in the white matter underlying any of these three.
8. Dead brain in the white matter underlying any of these three.
9. Spasticity preventing movement from occurring.

The latest here:

Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS

Jose G. Romano

,

Hannah Gardener

,

Iszet Campo-Bustillo

,

Yosef Khan

,

Sofie Tai

,

Nikesha Riley

,

Eric E. Smith

,

Ralph L. Sacco

,

Pooja Khatri

,

Heather M. Alger

,

Brian Mac Grory

,

Deepak Gulati

, … See all authors

and on behalf of the MaRISS Investigators*

Originally published5 May 2021https://doi.org/10.1161/STROKEAHA.120.032809Stroke. 2021;52:1995–2004

• This article is commented on by the following:

Abstract

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Background and Purpose:

Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population.

Methods:

This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase.

Results:

A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded (<1%).

Conclusions:

A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02072681.