Objective The aim of the study was to identify which neurologic impairment scales correlate with ambulation status in adults with spina bifida. Design A retrospective chart review was performed on patients seen at the University of Pittsburgh Medical Center Adult Spina Bifida Clinic. Findings were graded using several neurologic impairment scales: two versions of the National Spina Bifida Patient Registry classification, the International Standards for Neurological Classification of Spinal Cord Injury motor level, and the Broughton Neurologic Impairment Scale. Ambulation ability was ranked using the Hoffer classification system. Results Data collected from 409 patient records showed significant correlations between Hoffer ambulation status and all neurologic impairment scales evaluated. The strongest correlation was noted with the Broughton classification (r s = −0.771, P < 0.001). High correlations were also noted with both versions of the National Spina Bifida Patient Registry: strength 3/5 or greater (r s = −0.763, P < 0.001), and strength 1/5 or greater (r s = −0.716, P < 0.001). For the International Standards for Neurological Classification of Spinal Cord Injury motor level, only a moderate correlation was observed (r s = −0.565, P < 0.001). Conclusions Multiple grading scales can be used to measure motor function in adult spina bifida patients. Although the Broughton classification seems to be the most highly correlated with ambulation status, the less complex National Spina Bifida Patient Registry scale is also highly correlated and may be easier to administer in busy clinic settings. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Explain the clinical significance of identifying ambulation status and maximizing ambulation potential in adults with spina bifida; (2) Describe each of the neurologic grading scales examined in this study, identifying potential shortcomings in applying them to the adult spina bifida population; and (3) Administer the National Spina Bifida Patient Registry (NSBPR) impairment scale motor assessment in a standard adult spina bifida outpatient clinic visit. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Objective: Elevated blood glucose levels adversely affect the outcome of patients with acute ischemic stroke (AIS). We sought to study the predictive value of admission hemoglobin A1c (HbA1c) in AIS patients’ outcomes following intra-arterial stroke treatment (IAT). METHODS: We reviewed records of AIS patients who underwent IAT at our center from July 2012 - July 2013. The following data were collected and analyzed: patients’ demographics, baseline characteristics, treatment times and methods, rate of symptomatic and asymptomatic intracerebral hemorrhage, and favorable clinical outcome defined as modified Rankin score (mRS) ≤ 2 at 90 days or at last observation for patients treated within the last 90 days. HbA1c level was checked as part of routine stroke admission orders on all patients. RESULTS: Seventy consecutive patients who underwent IAT were identified. There were 42 (60%) females with mean cohort age of 64.4. The median ASPECT score was 9 (IQR 8-9) and baseline median National Institute of Health Stroke Scale Score was 18 (IQR 14-21). Overall 33 (47.1%) patients had favorable outcome. There were 15/70 (21.4%) asymptomatic and 2/70 (2.8%) symptomatic hemorrhages following IAT. Patients who developed hemorrhagic complications (17/70, 24%) following IAT had higher mean HbA1c levels (6.5 vs 5.9), however this finding was not statistically significant (ttest, p=0.09). Patients with favorable outcomes had lower mean admission HbA1c 5.9 (95% CI 5.6-6.2) versus 6.4 (95% CI 5.9-6.8). This finding was statistically significant (t-test, p 0.04). Multivariate logistic regression model identified low age (OR 0.93, 95%CI 0.88-0.99, p=0.03) as the only predictor of favorable outcome. CONCLUSION: Our study results indicate that admission HbA1c is a predictor of outcome in patients undergoing IAT for AIS. The value of this finding should be explored in a larger cohort.
Objective: We sought to compare the clinical outcomes of patients who underwent Intra-arterial Treatment (IAT) IAT with or without IV tPA pretreatment at our center. METHODS: We reviewed records of AIS patients who underwent IAT at our center from July 2012 - Jul 2013. The following data were collected and analyzed: patients’ demographics, baseline characteristics, treatment times and methods, rate of symptomatic and asymptomatic intracerebral hemorrhage, and favorable clinical outcome defined as modified Rankin score (mRS) ≤ 2 at 90 days or at last observation for patients treated within the last 89 days RESULTS: Seventy consecutive patients who underwent IAT were identified. Overall 33 (47.1%) patients had favorable outcome. There were 15/70 (21.4%) asymptomatic and 2/70 (2.8%) symptomatic hemorrhages following IAT. Pretreatment with IV tPA 32/70 (45.7%) had no significant impact on the rate of asymptomatic (6/32, 18.7% versus 9/38, 23.6%) or symptomatic (1/32, 0.03% versus 1/38, 0.03%) ICH, p=0.8. There were no instances of retroperitoneal or groin hemorrhagic complications in either group. Rate of recanalization was comparable between the IV tPA (26/32, 81.2%) and non-IV tPA groups (32/38, 84.2%).Also the rate of favorable outcome was comparable between the IV tPA pretreatment (15/32, 46.8%) and non-IV tPA (18/38, 47.3%) groups. In a multivariate analysis, young age was the only predictor of favorable clinical outcome in this cohort (OR: 0.93; 95%CI: 0.88-0.99; p=0.03). CONCLUSION: Our results suggest that IV tPA pretreatment has no impact on eventual patient outcome following endovascular stroke treatment. This finding may be helpful in designing future randomized trials.
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