Background and Purpose— An accurate prognosis is useful for patients, family, and service providers after acute stroke. Methods— We validated the Stroke subtype, Oxfordshire Community Stroke Project Classification, Age, and prestroke Rankin stroke score in predicting inpatient and 7-day mortality using data from 8 National Health Service hospital trusts in the Anglia Stroke and Heart Clinical Network between September 2008 and April 2011. Results— A total of 3547 stroke patients (ischemic, 92%) were included. An incremental increase of inpatient and 7-day mortality was observed with increase in Stroke subtype, Oxfordshire Community Stroke Project Classification, Age, and prestroke Rankin stroke score. Using a cut-off of ≥3, the area under the receiver operator curves values for inpatient and 7-day mortality were 0.80 and 0.82, respectively. Conclusions— A simple score based on 4 easily obtainable variables at the point of care may potentially help predict early stroke mortality.
BackgroundStroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors.Methods/DesignWe will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses.DiscussionThis study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.
In order to assess the feasibility and outcome of using prehospital thrombolysis in acute myocardial infarction in a rural community, we performed an open randomized study of patients with symptoms of acute myocardial infarction of less than 6 hours. One hundred and forty-five patients with acute myocardial infarction were allocated to receive IV streptokinase prehospital by means of a mobile coronary care unit (MCCU) (n = 43) or to receive IV streptokinase in hospital (n = 102). The mean delay time to treatment was 138 minutes (MCCU group) and 172 minutes (hospital group) (p less than 0.02). Reperfusion time was 88 minutes for the MCCU group and 92 minutes for the hospital group. Mortality at 14 days was 2.3% for the MCCU group and 11.7% for the hospital group (p less than 0.05). Six month mortality was 4.9% for the MCCU group and 17.3% for the hospital group (p = 0.03). Mortality at 1 year was 6.1% for the MCCU group and 20.0% for the hospital group (p = 0.04). There were no significant adverse events in either treatment group. Thus, prehospital thrombolysis by streptokinase is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in both short- and long-term survival with no apparent reduction in safety profile.
Results: A total of 3,597 patients (mean age 77 years) with first-ever or recurrent stroke (92% ischaemic) were included. Increasing LOS was observed with increasing SOAR stroke score (p<0.001 for both mean and median) and the SOAR stroke score of 0 had the shortest mean LOS (12±20 days) while the SOAR stroke score of 6 had the longest mean LOS (26±28 days). Among participants who were discharged alive, increasing SOAR stroke score had a significantly higher mean and median LOS (p<0.001 for both mean and median) and the LOS peaked among participants with score value of 6 (mean (sd) 35±31 days, median (IQR) 23 (14-48) days). For participants who died as in-patient, there was no significant difference in mean or median LOS with increasing SOAR stroke score (p=0.68 &p=0.79 respectively). Conclusion:This external validation study confirms the usefulness of the SOAR stroke score in predicting LOS in patients with acute stroke especially in those who are likely to survive to discharge. This provides a simple prognostic score useful for clinicians, patients and service providers. 4 What's known? Previous studies have identified predictors of length of stay (LOS) in acute stroke. Currently, there has yet to be a system that is routinely implemented to predict LOS in acute stroke. We previously developed the SOAR stroke score to predict mortality and LOS among stroke patients but this score has not been externally validated for LOS outcome. What's new? We have confirmed the usefulness of the SOAR stroke score in predicting LOS.Higher scores were associated with prolonged hospital stay among patients who survived to discharge. The SOAR stroke score can be routinely implemented to provide likely LOS of acute stroke admissions for service providers, healthcare staff and patients and relatives particularly in lower range where the chance of survival to discharge is greater.5
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