Survivors don't care about 'prognostication' or 'care'; they want you to DELIVER RECOVERY! This does nothing of the sort! COMPLETELY FUCKING USELESS! You're fired! You first have to create 100% recovery protocols, then every 'prognostication' is 100% recovery! My God, the stroke medical world is full of complete blithering idiots!
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely refute all my points with NO EXCUSES!! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.
Flipping the Script: Early Neurological Gains May Redefine Recovery Prognostication After Intracerebral Hemorrhage
Neuroprognostication
has long been a formidable challenge, with clinicians often grappling
to predict outcomes accurately in the chaotic aftermath of intracerebral
hemorrhage (ICH). This uncertainty is important to recognize as it
directly impacts critical decisions about life-sustaining therapies,
rehabilitation planning, and the guidance that we offer to families as
they navigate the most devastating forms of stroke. Neuroprognostication
matters,1 (NO; it's completely useless!)because it shapes hope, sets expectations, and informs care(NOT RECOVERY!) pathways
for patients, their families, and care(NOT RECOVERY!) teams. In this issue of Stroke,
a post hoc analysis of the INTERACT2 trial (Intensive Blood Pressure
Reduction in Acute Cerebral Hemorrhage Trial) provides a much-needed
lens to examine recovery, highlighting subacute neurological improvement
(SNI) as a measurable and meaningful marker.2
By linking early changes in neurological status—captured between 24
hours and 7 days post-ICH—with long-term functional outcomes, the study
bridges a critical gap between acute observations and favorable
prognostic insight.2
The study analyzed data from the INTERACT2 trial, which included over
2800 patients with acute ICH to examine factors influencing recovery.
SNI was defined as a significant reduction in the National Institutes of
Health Stroke Scale (NIHSS), measured within 72 hours of ICH. The
primary outcome was functional recovery (modified Rankin Scale) at 90
days. SNI was found to be a predictor of favorable outcomes, independent
of baseline hematoma volume and other initial clinical factors. The
study demonstrates that even modest SNI (≥1-point improvement in NIHSS)
significantly reduces the odds of death and major disability at 90 days.
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