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Background and Purpose-We sought to test the hypothesis that breathing 100% oxygen for the first 24 hours after an acute stroke would not reduce mortality, impairment, or disability. Methods-Subjects admitted to the Central Hospital of Akershus, Norway, with stroke onset Ͻ24 hours before admittance were allocated to 2 groups by a quasi-randomized design using birth numbers. All patients with acute stroke admitted to hospital within 24 hours after a stroke were included and enrolled. Patients were allocated to a group that received supplemental oxygen treatment (100% atmospheres, 3 L/min) for 24 hours (nϭ292) or to the control group, which did not receive additional oxygen. Main outcome measures were 1-year survival, neurological impairment (Scandinavian Stroke Scale), and disability (Barthel Index) 7 months after stroke. Results-One-year survival was 69% in the oxygen group and 73% in the control group (OR 0.82; 95% CI 0.57 to 1.19; Pϭ0.30). Impairment scores and disability scores were comparable 7 months after stroke. Among patients with Scandinavian Stroke Scale (SSS) scores of Ն40, 82% in the oxygen group and 91% in the control group survived (OR 0.45; 95% CI 0.23 to 0.90; Pϭ0.023). For patients with SSS scores of Ͻ40, 53% in the oxygen group and 48% in the control group survived (OR 1.26; 95% CI 0.76 to 2.09; Pϭ0.54). Conclusions-Supplemental oxygen should not routinely be given to nonhypoxic stroke victims with minor or moderate strokes. Further research is needed to give conclusive advice concerning oxygen supplementation for patients with severe strokes.

Summary:Purpose: The aims of the study were to assess the occurrence of poststroke epilepsy (PSE) in patients with ischemic strokes, to identify predictors, and to investigate whether treatment in a stroke unit (SU) influenced the long-term outcomes of epilepsy.Methods: Patients with PSE, defined as those having two ore more unprovoked epileptic seizures ≥1 week after an ischemic stroke, were identified from a cohort of 484 patients with ischemic strokes. The patients were prospectively assessed 7-8 years after stroke or until death. Different variables were studied to look for possible predictors.Results: From 484 patients with ischemic strokes, PSE developed in 12 (2.5%) and 15 (3.1%) patients during the first year and 7-8 years after stroke, respectively. Eight (53%) of these patients were treated in a stroke unit (SU), and seven (47%) were treated in a general medical ward (GMW). The mean age of those who developed PSE and those who did not was 74.3 years and 76.3 years, respectively. In a multivariate analysis, a Scandinavian Stroke Scale (SSS) score <30 on admission was a significant predictor for developing PSE [odds ratio (OR), 4.9; p = 0.004).Conclusions: The prevalence of PSE, 7 to 8 years after an ischemic stroke, was 3.1%. SSS scores <30 on admission were a significant predictor for PSE. Neither treatment in SU versus GMW, cortical location, nor age at onset of stroke seemed to influence the risk of developing PSE.

Severe strokes, use of ambulance and lower age are associated with reduced prehospital delay. The present study shows that more than half of the delay is caused by the hesitation to contact medical services. Public information campaigns should focus on fast symptom recognition and the importance of immediately contacting the Emergency Medical Services upon symptom onset.

The COVID-19 declared pandemic by the World Health Organization (WHO) in March 2020 challenges healthcare systems and societies worldwide. 1,2 Many health professionals have questioned whether the public anxiety around COVID-19 discourages some patients from contacting the healthcare system. After the pandemic lockdown in the UK, there was a 25% fall in emergency room attendances the first week. 3 If this fall continues, it may be asked whether a substantial proportion of the population are missing treatment opportunities with potentially long-term harm as a consequence. Rapid admission to hospital following stroke is vital in ensuring patients have timely access to treatments such as thrombolysis and endovascular treatment. 4 The effect of acute stroke treatment is highly time dependent with late admission being an independent predictor of worse outcome. 5-8 It is therefore feared that a large number of stroke patients are at increased risk of dependency or death if they do not seek emergency help. During the pandemic, there have been many anecdotal reports that the number of stroke patients seen in the emergency

Background and Purpose-Very early mobilization (VEM) is considered to contribute to the beneficial effects of stroke units, but there are uncertainties regarding the optimal time to start mobilization. We hypothesized that VEM within 24 hours after admittance to the hospital would reduce poor outcome 3 months poststroke compared with mobilization between 24 and 48 hours. Methods-We conducted a prospective, randomized, controlled trial with blinded assessment at follow-up. Patients admitted to the stroke unit within 24 hours after stroke were assigned to either VEM within 24 hours of admittance or mobilization between 24 and 48 hours (control group). Primary outcome was the proportion of poor outcome (modified Rankin scale score, 3-6), whereas secondary outcomes were death rate, change in neurological impairment (National Institutes of Health Stroke Scale score), and dependency (Barthel Index 0 -17). Results-Fifty-six patients were included (mean ageϮSD, 76.9Ϯ9.4 years), 27 were in the VEM group and 29 were in the control group. VEM patients had nonsignificant higher odds (adjusted for age and National Institutes of Health Stroke Scale score on admission) of poor outcome (OR, 2.70; 95% CI, 0.78 -9.34; Pϭ0.12), death (OR, 5.26; 95% CI, Pϭ0.08), and dependency (OR, 1.25; 95% CI, 0.36 -4.34; Pϭ0.73). The control group, having milder strokes (National Institutes of Health Stroke Scale scoreϮSD: control group, 7.5Ϯ4.2; VEM, 9.2Ϯ6.5; Pϭ0.26), had better neurological improvement (Pϭ0.02). Conclusions-We identified a trend toward increased poor outcome, death rate, and dependency among patients mobilized within 24 hours after hospitalization, and an improvement in neurological functioning in favor of patients mobilized between 24 and 48 hours. Very early or delayed mobilization after acute stroke is still undergoing debate, and results from ongoing larger trials are required.

Background and Purpose-Research evidence supporting Early Supported Discharge (ESD) services has been summarized in a Cochrane Systematic Review. Trials have shown that ESD can reduce long-term dependency and admission to institutional care and reduce the length of hospital stay. No adverse impact on the mood or well-being of patients or carers has been reported. With the implementation of many national and international stroke initiatives, we felt it timely to reach consensus about ESD among trialists who contributed to the review. Methods-We used a modified Delphi approach with 10 ESD trialists. An agreed list of statements about ESD was generated from the Cochrane review and three rounds of consultation completed. ESD trialists rated statements regarding team composition, model of team work, intervention, and success. Results-Consensus of opinion (Ͼ75% agreement) was obtained on 47 of the 56 statements. Multidisciplinary, specialist stroke ESD teams should plan and co-ordinate both discharge from hospital and provide rehabilitation in the community. Specific eligibility criteria (safety, practicality, medical stability, and disability) need to be followed to ensure this service is provided for mild to moderate stroke patients who can benefit from ESD. Length of stay in hospital, patient and carer outcome measures and cost, need to be routinely audited. Conclusions-We have created a consensus document that can be used by commissioners and service providers in implementing ESD services. Our aim is to promote the use of recommendations derived from research findings to facilitate successful implementation of stroke services nationally and internationally. (Stroke. 2011;42:1392-1397.)

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