Early and Continuous Neurologic Improvements after Intravenous Thrombolysis Are Strong Predictors of Favorable Long-term Outcomes in Acute Ischemic Stroke

Yeo, Leonard L.L.; Paliwal, Prakash; Teoh, Hock Luen; Seet, Raymond C.S.; Chan, Bernard P.L.; Wakerley, Benjamin R; Shen, Liang; Rathakrishnan, Rahul; Chong, Vincent; Ting, Eric; Sharma, Vijay K.

doi:10.1016/j.jstrokecerebrovasdis.2013.07.024

Cited by 62 publications

(48 citation statements)

References 36 publications

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“…Among the Class III observational studies, there was wide variability in baseline stroke severity (mean NIHSS scores ranged from 5 to 17), making comparisons difficult. 33,36,37,39,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] …”

Section: Potential Benefitsmentioning

confidence: 99%

“…25 Among other Class III studies, 33,36,37,41,44,50,55,56,58,61,66,[68][69][70][71][72][73][74][75][76][77] the prevalences of sICH associated with IV tPA administration within 4.5 hours ranged from 3% to 8% when based on the NINDS definition, whereas the prevalence was lower (2% to 6%) for those studies using an sICH definition requiring a change of 4 or more on the NIHSS. 39,53,54,57,60,[62][63][64][65]67,[78][79][80][81][82][83][84] …”

Section: Potential Harmsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Brown¹,

Burton²,

Nazarian³

et al. 2015

Annals of Emergency Medicine

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Section: Potential Benefitsmentioning

confidence: 99%

Section: Potential Harmsmentioning

confidence: 99%

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Brown¹,

Burton²,

Nazarian³

et al. 2015

Annals of Emergency Medicine

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“…[13,46] Recent literature has associated improvement in stroke severity scores at 2 and 24 hours with improved functional outcomes at three months. [47] We also recognize that improvements in preventive, acute, and follow-up care make a difference in outcomes. [48,49] Despite these multi-dimensional processes, we found an improvement in IV tPA administration rates with availability of a CPOE-EHR as well as even greater improvement when an ED stroke order set was used.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke

Ballard

Kim

Huang

et al. 2015

Annals of Emergency Medicine

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Objective Electronic Health Record (EHR) systems with computerized physician order entry (CPOE) and condition-specific order sets are intended to standardize patient management and minimize errors of omission. However, the impact of these systems on disease-specific process measures and patient outcomes is not well established. We sought to evaluate the impact of CPOE-EHR implementation on process measures and short-term health outcomes for patients hospitalized with acute ischemic stroke. Methods We conducted a quasi-experimental cohort study of patients hospitalized for acute ischemic stroke with concurrent controls that took advantage of the staggered implementation of a comprehensive CPOE-EHR across 16 medical centers within an integrated healthcare delivery system from 2007 to 2012. The study population included all patients admitted to the hospital from the Emergency Department (ED) for acute ischemic stroke with an initial neuroimaging study within 2.5 hours of ED arrival. We evaluated the association between the availability of a CPOE-EHR and the rates of 1) ED intravenous tissue plasminogen activator (IV tPA) administration, 2) hospital-acquired pneumonia (PNA) and 3) inhospital and 90-day mortality using doubly robust estimation models to adjust for demographics, comorbidities, secular trends, and concurrent primary stroke center certification status at each center. Results Of 10,081 eligible patients, 6,686 (66.3%) were treated in centers after CPOE-EHR had been implemented. CPOE was associated with significantly higher rates of IV tPA administration (rate difference 3.4%, 95% CI; 0.8%, 6.0%) but not with rate differences in PNA or mortality. Conclusions For patient hospitalized for acute ischemic stroke, CPOE use was associated with increased use of IV tPA.

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“…Acute cerebral infarction (ACI) is a common cerebrovascular disease that seriously endangers human health, and has high morbidity, mortality, disability and recurrence rate. [1][2][3] Cerebral infarction is a hypoxic and ischemic necrosis induced by insufficient blood supply of the local brain, which results from a blockage or narrowing in the arteries, and the blockage can be due to a thrombus, an embolus or an atheromatous stenosis of one or more arteries. [4,5] Major risk factors for cerebral infarction are generally the same as for atherosclerosis: high blood pressure, Diabetes mellitus, tobacco smoking, obesity, and dyslipidemia.…”

Section: Introductionmentioning

confidence: 99%

Application of concomitant disease scoring in acute cerebral infarction

Xin

Liu

et al. 2019

Preprint

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Background: This study aims to explore the predictive value of concomitant disease scoring for the prognosis of patients with acute cerebral infarction (ACI). Methods: A total of 399 patients with ACI, who met the inclusion criteria, were enrolled into the present study. The concomitant disease score was assessed within 24 hours after admission, and the risk degree of death was analyzed. Then, the goodness of fit test and validity analysis were carried out, the best survival/death cut-off value was determined, and its predictive value for the prognosis of ACI patients was assessed. Results: The area under the receiver operating characteristic (ROC) curve for the concomitant disease score was 0.700, the distinctiveness was relatively good, and the prediction cut-off value was 10 points. Furthermore, the mortality rate of patients with a higher score was significantly higher, when compared to patients with a lower score. Conclusion: This concomitant disease score has good predictive value for the prognosis of ACI patients, and is an ideal system for evaluating the condition of cerebral infarction. The survival/death cut-off value was 10 points.

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Early and Continuous Neurologic Improvements after Intravenous Thrombolysis Are Strong Predictors of Favorable Long-term Outcomes in Acute Ischemic Stroke

Cited by 62 publications

References 36 publications

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke

Application of concomitant disease scoring in acute cerebral infarction

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