Background-Neurologic deterioration (ND) occurs in one-third of patients with stroke. However, the true incidence of ND and risk for adverse outcomes remains unknown because no standardized definition of ND exists. Our study compared the prognostic value of a range of definitions for ND in patients with acute ischemic stroke (AIS).

ImportanceSARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.ObjectiveTo develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and ParticipantsProspective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPASC and 44 participant-reported symptoms (with severity thresholds).ResultsA total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.Conclusions and RelevanceA definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

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Leukocytosis at the time of ND correlates with poor functional outcomes and may represent a marker of greater cerebral damage through increased parenchymal inflammation.

Certain self-reported study habits may correlate with a higher Step 1 score compared with others. Given the importance of achieving a high Step 1 score on residency choice, it is important to further identify which characteristics may lead to a higher score.

Introduction Neurological deterioration (ND) following ischemic stroke has been shown to impact short-term functional outcome and is associated with in-hospital mortality. Methods Patients with acute ischemic stroke who presented between 07/08–12/10 were identified and excluded for in-hospital stroke, presentation >48hrs since last seen normal, or unknown time of last seen normal. Clinical and laboratory data, National Institutes of Health Stroke Scale (NIHSS) scores, and episodes of ND (increase in NIHSS score ≥2 within a 24hr period) were investigated. Results Of the 596 patients screened, 366 were included (median age 65 y, 42.1% female, 65.3% black). Of these, 35.0% experienced ND. Patients with ND were older (69 vs. 62 y, p<0.0001), had more severe strokes (median admission NIHSS 12 vs. 5, p<0.0001), carotid artery stenosis (27.0% vs. 16.8%, p=0.0275), and coronary artery disease (26.0% vs. 16.4%, p=0.0282) compared to patients without ND. Patients with ND had higher serum glucose on admission than patients without ND (125.5 vs. 114 mg/dL, p=0.0036). After adjusting for crude variables associated with ND, age >65 and baseline NIHSS>14 remained significant independent predictors of ND. In a logistic regression analysis adjusting for age and serum glucose, each 1-point increase in admission NIHSS was associated with a 7% increase in the odds of ND (OR 1.07 95%CI 1.04-1.10, p<0.0001). Conclusions Older patients and patients with more severe strokes are more likely to experience ND. Initial stroke severity was the only significant, independent, and modifiable risk factor for ND, amenable to recanalization and reperfusion.

Objectives Lung ultrasound (LUS) can accurately diagnose several pulmonary diseases, including pneumothorax, effusion, and pneumonia. LUS may be useful in the diagnosis and management of COVID‐19. Methods This study was conducted at two United States hospitals from 3/21/2020 to 6/01/2020. Our inclusion criteria included hospitalized adults with COVID‐19 (based on symptomatology and a confirmatory RT‐PCR for SARS‐CoV‐2) who received a LUS. Providers used a 12‐zone LUS scanning protocol. The images were interpreted by the researchers based on a pre‐developed consensus document. Patients were stratified by clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death within 28 days from the initial symptom onset) and time from symptom onset to their scan. Results N = 22 patients (N = 36 scans) were included. Eleven (50%) patients experienced clinical deterioration. Among N = 36 scans, only 3 (8%) were classified as normal. The remaining scans demonstrated B‐lines (89%), consolidations (56%), pleural thickening (47%), and pleural effusion (11%). Scans from patients with clinical deterioration demonstrated higher percentages of bilateral consolidations (50 versus 15%; P = .033), anterior consolidations (47 versus 11%; P = .047), lateral consolidations (71 versus 29%; P = .030), pleural thickening (69 versus 30%; P = .045), but not B‐lines (100 versus 80%; P = .11). Abnormal findings had similar prevalences between scans collected 0–6 days and 14–28 days from symptom onset. Discussion Certain LUS findings may be common in hospitalized COVID‐19 patients, especially for those that experience clinical deterioration. These findings may occur anytime throughout the first 28 days of illness. Future efforts should investigate the predictive utility of these findings on clinical outcomes.

Background Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID‐19. Previously described LUS manifestations for COVID‐19 include B‐lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID‐19 is unknown. Methods This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans ( n = 180 independent observations) collected from patients with COVID‐19, diagnosed via RT‐PCR. These studies were randomly selected from an image database consisting of COVID‐19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values ( κ ) were used to calculate IRR. Results There was substantial IRR on the following items: normal LUS scan ( κ = 0.79 [95% CI: 0.72–0.87]), presence of B‐lines ( κ = 0.79 [95% CI: 0.72–0.87]), ≥3 B‐lines observed ( κ = 0.72 [95% CI: 0.64–0.79]). Moderate IRR was observed for the presence of any consolidation ( κ = 0.57 [95% CI: 0.50–0.64]), subpleural consolidation ( κ = 0.49 [95% CI: 0.42–0.56]), and presence of effusion ( κ = 0.49 [95% CI: 0.41–0.56]). Fair IRR was observed for pleural thickening ( κ = 0.23 [95% CI: 0.15–0.30]). Discussion Many LUS manifestations for COVID‐19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID‐19 may include the presence/count of B‐lines or determining if a scan is normal. Clinical protocols for LUS with COVID‐19 may require additional observers for the confirmation of less reliable findings such as consolidations.