To determine the diagnostic accuracy of state, minimally invasive clinical and physical signs (or sets of signs) to be used as screening tests for detecting impending or current water-loss dehydration, or both, in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. 1 Clinical and physical signs for identification of impending and current water-loss dehydration in older people (Protocol)

Background and Purpose-We aimed to determine the frequency of dehydration, risk factors, and associations with outcomes at hospital discharge after stroke. Methods-We linked clinical data from stroke patients in 2 prospective hospital registers with routine blood urea and creatinine results. Dehydration was defined by a blood urea-to-creatinine ratio Ͼ80. Results-Of 2591 patients registered, 1606 (62%) were dehydrated at some point during their admission. Independent risk factors for dehydration included older age, female gender, total anterior circulation syndrome, and prescribed diuretics (all PϽ0.001). Patients with dehydration were significantly more likely be dead or dependent at hospital discharge than those without ( 2 ϭ170.5; degrees of freedomϭ2; PϽ0.0001). Conclusions-Dehydration is common and associated with poor outcomes. Further work is required to establish if these associations are causal and if preventing or treating dehydration improves outcomes. (Stroke. 2012;43:857-859.)

Objectives: To assess organisational and patient specific limitations and safety of magnetic resonance imaging (MRI) as the first line investigation for hospital admitted stroke patients. Methods: Consecutive patients admitted with acute stroke were assessed and an attempt was made to perform MRI in all patients. Oxygen saturation and interventions required during scanning were recorded. Results: Among 136 patients recruited over 34 weeks, 85 (62%) underwent MRI. The patients' medical instability (15 of the 53 not scanned), contraindications to MRI (six of the 53 not scanned), and rapid symptom resolution (10 of the 53 not scanned) were the main reasons for not performing MRI. Of the 85 patients who underwent MRI, 26 required physical intervention, 17 did not complete scanning, and 11 of the 61 who had successful oxygen saturation monitoring were hypoxic during MRI. Organisational limitations accounted for only 13% of failures to scan. Conclusions: Up to 85% of hospital admitted acute stroke patients could have MRI as first line imaging investigation, but medical instability is the major limitation. Hypoxia is frequent in MRI. Patients should be monitored carefully, possibly by an experienced clinician, during scanning. M agnetic resonance imaging (MRI) has been advocated as a method of improving the selection of patients with stroke for thrombolysis.1 However, MRI has more contraindications, is more difficult to perform in ill patients, and takes longer than computed tomography scanning.The current issue is to determine the proportion of patients with acute stroke in whom MRI is achievable, and how to identify (in the acute situation) those in whom MRI is unlikely to be successful. Studies of imaging appearances in selected patients, 2 or which were retrospective but gave no indication of the actual number of suspected strokes not referred for MRI in the same time period, 3 4 have not provided such information. One recent prospective study found that 20% of 144 stroke patients recruited ''at the hospital door'' could not have MRI (of whom half had MRI contraindications and half were medically unstable).5 No study has investigated whether MRI is safe in acute stroke.We aimed to determine: (1) whether it was possible to use MRI as the first line assessment for all suspected acute strokes, and (2) the limitations and safety of MRI in acute stroke. METHODSFrom among all consecutive admissions to our hospital (population served, 500 000) with suspected acute stroke, patients were eligible for the MRI feasibility study if they could be assessed by a clinical research fellow and scanned within 24 hours of stroke, and the clinical diagnosis was probable or definite stroke (transient ischaemic attacks and obvious non-strokes were excluded).We recorded time of stroke and assessment, clinical features, neurological deficit (National Institutes of Health Stroke Scale Score (NIHSS): http://www.strokecenter.org/ trials/scales/) and stroke subtype. 6 An experienced neurologist assessed the risk of complications occurring duri...

Enteral feeding tubes, a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG), are commonly used to provide nutrition, hydration and essential medications to stroke patients who cannot swallow. Early tube feeding is associated with improved survival after stroke and it is recommended that patients start tube feeding within 24 hours of hospital admission. NGT feeding is the preferred method for short-term feeding in the acute phase of stroke as it has the advantage of being easily placed at the bedside. However, there are often difficulties inserting the NGT and it can be easily dislodged by agitated and confused patients, leading to potentially fatal complications. A PEG tube is considered a more secure method of feeding stroke patients who require longer-term nutritional support, but it is an invasive procedure that can result in complications that are associated with an increased risk of morbidity and mortality after stroke. The aim of this article is to review the complications associated with enteral feeding tubes and discuss their prevention and management for stroke patients.

Background: Hypoxaemia in the acute phase of stroke might damage the ischaemic penumbra and worsen clinical outcome. We determined the frequency of hypoxaemia on admission with stroke and assessed whether it was related to outcome. Methods: We measured arterial oxygen saturation (SaO₂) and breathing effort with portable monitoring equipment in a large cohort of acute stroke patients, continually from arrival at hospital, during interdepartment transfer, in imaging and on the ward. Patients received best medical care according to current guidelines. Baseline neurological examination and 3-month outcome (Modified Rankin Scale) were assessed blind to other data. Hypoxaemia was defined as SaO₂ <90% for ≧10% of each assessment stage. Results: Mean SaO₂ was lowest during transfers (p < 0.01), but hypoxaemia was common in all assessment stages. Patients with hypoxaemia (30/153, 20%) were more likely to have a pre-existing respiratory disease on admission than those without hypoxaemia (p < 0.04). More patients with hypoxaemia (40%) died than those without hypoxaemia (20%) (hazard ratio, 2.0; 95% CI, 1.0–4.1), though after adjusting for National Institute of Health Stroke Scale and age this association was not statistically significant (hazard ratio, 1.5; 95% CI, 0.7–3.1). There were similar numbers of dependent survivors in both groups. Conclusion: Hypoxaemia during acute stroke assessment was associated with increased risk of death. Although SaO₂ is lower during transfers, hypoxaemia occurs in all stages of the admission process. Further research is necessary to determine whether strategies to avoid hypoxaemia during acute assessment improve stroke survival.