You do realize survivors want prevention of early neurological deterioration rather than this USELESS PREDICTION? I'd have you all fired!
Early neurological deterioration in patients with minor stroke: A single-center study conducted in Vietnam
PLOS One | https://doi.org/10.1371/journal.pone.0323700 May 19, 2025 1 / 13
OPEN ACCESS
Citation: Nguyen DT, Mai TD, Dao PV, Ha
HT, Fabus M, Fleming M, et al. (2025) Early
neurological deterioration in patients with
minor stroke: A single-center study conducted
in Vietnam. PLoS One 20(5): e0323700. https://
doi.org/10.1371/journal.pone.0323700
Editor: Atakan Orscelik, UCSF: University of
California San Francisco, UNITED STATES OF
AMERICA
Received: November 29, 2024
Accepted: April 13, 2025
Published: May 19, 2025
Copyright: © 2025 Nguyen et al
. This is an
open access article distributed under the terms
of the Creative Commons Attribution License,
which permits unrestricted use, distribution,
and reproduction in any medium, provided the
original author and source are credited.
Data availability statement: All relevant data
are in the article and its Supporting information
files.
Funding: The author(s) received no specific
funding for this work.
RESEARCH ARTICLE
Early neurological deterioration in patients with
minor stroke: A single-center study conducted in
Vietnam
Dung Tien Nguyen1,2,3, Ton Duy Mai 1,2,3*, Phuong Viet Dao1,2,3, Hung Tran Ha3,
Marco Fabus4, Melanie Fleming4, Minh Cong Tran4
1 Bach Mai Stroke Center, Bach Mai Hospital, Hanoi, Vietnam, 2 Vietnam National University-University
of Medicine and Pharmacy, Hanoi, Vietnam, 3 Hanoi Medical University, Hanoi, Vietnam, 4 Nuffield
Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
* tonresident@gmail.com
outcomes at 90 days when there is early neurological deterioration (END). The
objective of this case-control study conducted in a comprehensive stroke facility in
Vietnam is to examine the frequency, forecast, and outcomes of patients with END
in minor strokes. The study employs a descriptive observational design, longitudi-
nally tracking patients with minor strokes admitted to Bach Mai Hospital’s Stroke
Center between December 1, 2023, and August 31, 2024. Hospitalized within 24
hours of symptom onset, minor stroke patients with National Institutes of Health
Stroke Scale (NIHSS) scores ≤ 5 and items 1a, 1b, and 1c on the NIHSS scale,
each equal to 0, were included in the study. The primary measure of interest is
the END rate, defined as a rise of 2 or more points in the NIHSS score during the
first 72 hours after admission. We conduct a logistic regression analysis to identify
forecasting factors for END. Out of 839 patients, 88 (10.5%) had END. In the END
group, we found that most patients had complications within the first 24 hours of
stroke, accounting for 43.2%; the 24 – 48-hour window accounted for 35.2%, and
the 48 – 72-hour window accounted for 21.6%. END was associated with a higher
likelihood of poor outcomes (mRS 2 – 6) at discharge (OR = 22.76; 95% CI 11.22 –
46.20; p < 0.01), 30 days post-stroke(OR = 24.38; 95% CI 14.40 – 41.29; p < 0.01),
and 90 days post-stroke (OR = 21.74; 95% CI 12.63 – 37.43; p < 0.01). Some of
the prognostic factors for END were admission NIHSS score (OR = 1.24; 95% CI
1.03 – 1.49; p = 0.02), admission systolic blood pressure greater than 150mmHg
(OR = 1.70; 95% CI 1.03 – 2.81; p = 0.04), admission blood glucose (OR = 1.07;
95% CI 1.01 – 1.14; p = 0.02), reperfusion therapy (OR = 3.35; 95% CI 1.50 – 7.49;
p < 0.01), use of antiplatelet monotherapy (OR = 3.69; 95% CI 2.24 – 6.08; p < 0.01),
internal capsule infarction (OR = 2.54; 95% CI 1.37 – 4.71; p < 0.01), hemorrhagic
OPEN ACCESS
Citation: Nguyen DT, Mai TD, Dao PV, Ha
HT, Fabus M, Fleming M, et al. (2025) Early
neurological deterioration in patients with
minor stroke: A single-center study conducted
in Vietnam. PLoS One 20(5): e0323700. https://
doi.org/10.1371/journal.pone.0323700
Editor: Atakan Orscelik, UCSF: University of
California San Francisco, UNITED STATES OF
AMERICA
Received: November 29, 2024
Accepted: April 13, 2025
Published: May 19, 2025
Copyright: © 2025 Nguyen et al
. This is an
open access article distributed under the terms
of the Creative Commons Attribution License,
which permits unrestricted use, distribution,
and reproduction in any medium, provided the
original author and source are credited.
Data availability statement: All relevant data
are in the article and its Supporting information
files.
Funding: The author(s) received no specific
funding for this work.
RESEARCH ARTICLE
Early neurological deterioration in patients with
minor stroke: A single-center study conducted in
Vietnam
Dung Tien Nguyen1,2,3, Ton Duy Mai 1,2,3*, Phuong Viet Dao1,2,3, Hung Tran Ha3,
Marco Fabus4, Melanie Fleming4, Minh Cong Tran4
1 Bach Mai Stroke Center, Bach Mai Hospital, Hanoi, Vietnam, 2 Vietnam National University-University
of Medicine and Pharmacy, Hanoi, Vietnam, 3 Hanoi Medical University, Hanoi, Vietnam, 4 Nuffield
Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
* tonresident@gmail.com
Abstract
A minor ischemic stroke is associated with a higher likelihood of poor clinicaloutcomes at 90 days when there is early neurological deterioration (END). The
objective of this case-control study conducted in a comprehensive stroke facility in
Vietnam is to examine the frequency, forecast, and outcomes of patients with END
in minor strokes. The study employs a descriptive observational design, longitudi-
nally tracking patients with minor strokes admitted to Bach Mai Hospital’s Stroke
Center between December 1, 2023, and August 31, 2024. Hospitalized within 24
hours of symptom onset, minor stroke patients with National Institutes of Health
Stroke Scale (NIHSS) scores ≤ 5 and items 1a, 1b, and 1c on the NIHSS scale,
each equal to 0, were included in the study. The primary measure of interest is
the END rate, defined as a rise of 2 or more points in the NIHSS score during the
first 72 hours after admission. We conduct a logistic regression analysis to identify
forecasting factors for END. Out of 839 patients, 88 (10.5%) had END. In the END
group, we found that most patients had complications within the first 24 hours of
stroke, accounting for 43.2%; the 24 – 48-hour window accounted for 35.2%, and
the 48 – 72-hour window accounted for 21.6%. END was associated with a higher
likelihood of poor outcomes (mRS 2 – 6) at discharge (OR = 22.76; 95% CI 11.22 –
46.20; p < 0.01), 30 days post-stroke(OR = 24.38; 95% CI 14.40 – 41.29; p < 0.01),
and 90 days post-stroke (OR = 21.74; 95% CI 12.63 – 37.43; p < 0.01). Some of
the prognostic factors for END were admission NIHSS score (OR = 1.24; 95% CI
1.03 – 1.49; p = 0.02), admission systolic blood pressure greater than 150mmHg
(OR = 1.70; 95% CI 1.03 – 2.81; p = 0.04), admission blood glucose (OR = 1.07;
95% CI 1.01 – 1.14; p = 0.02), reperfusion therapy (OR = 3.35; 95% CI 1.50 – 7.49;
p < 0.01), use of antiplatelet monotherapy (OR = 3.69; 95% CI 2.24 – 6.08; p < 0.01),
internal capsule infarction (OR = 2.54; 95% CI 1.37 – 4.71; p < 0.01), hemorrhagic
PLOS One | https://doi.org/10.1371/journal.pone.0323700 May 19, 2025 2 / 13
transformation (OR = 5.72; 95% CI 1.07 – 30.45; p = 0.04), corresponding extracra-
nial carotid artery occlusion (OR = 4.84; 95% CI 1.26 – 18.65; p = 0.02), and middle
cerebral artery occlusion OR = 3.06; 95% CI 1.29 – 7.30; p = 0.01). END in minor
stroke patients accounts for 10.5% and is a risk factor for poor neurological out-
comes. Admission NIHSS score, higher systolic blood pressure, admission blood
glucose, reperfusion therapy, use of antiplatelet monotherapy, internal capsule
infarction, hemorrhagic transformation, corresponding extracranial carotid artery
occlusion, and middle cerebral artery occlusion were some of the prognostic factors
for END in our observational study.
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