Estimation of stroke severity with National Institutes of Health Stroke Scale grading and retinal features

Zhuo, Yuanyuan; Qu, Yimin; Wu, Jiaman; Huang, Xingxian; Yuan, Weiqu; Lee, John; Yang, Zhuoxin; Zee, Benny

doi:10.1097/md.0000000000026846

Cited by 12 publications

(7 citation statements)

References 35 publications

(60 reference statements)

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“…As such, retinal fundus photography is an important tool for translational vascular research. [366, 389, 384, 385, 378, 379, 394, 401, 367, 405, 390, 408, 368, 369, 398, 380, 365, 406, 370, 386, 395, 399, 403, 391, 412, 371, 387, 407, 372-374, 381, 375, 67, 402, 410, 404, 392, 400, 409, 393, 413, 376, 382, 377, 397] Microvascular health 6 [389,378,401,396,388,383] Analysis Vascular Plethysmography…”

Section: Discussionmentioning

confidence: 99%

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

et al. 2023

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Research involving human subjects in ambulatory settings is a critical link in the chain comprising translational research, spanning preclinical research to human subject and patient cohort studies. There are presently a wide array of techniques and approaches available to investigators wishing to study blood flow, perfusion, and vascular structure and function in human subjects. In this multi-sectioned review, we discuss capillaroscopy, carotid intima-media thickness, flow-mediated dilation, laser Doppler flowmetry, near-infrared spectroscopy, peripheral arterial tonometry, pulse wave velocity, retinal fundus imaging, and vascular plethysmography. Each section contains a general overview and the physical basis of the technique followed by a discussion of the procedures involved and the necessary equipment, with attention paid to specific requirements or limitations. Subsequently, we detail which aspects of vascular function can be studied with a given technique, the analytical approach to the collected data, and the appropriate application and limitation(s) to the interpretation of the data collected. Finally, a modified scoping review provides a summary of how each assessment technique has been applied in previous studies. It is anticipated that this review will provide an efficient source of information and insight for preclinical investigators seeking to add translational aspects to their research programs.

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Section: Discussionmentioning

confidence: 99%

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

et al. 2023

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“…Визначений наб ір даних про кожного з пацієнтів з МІ був внесений до спеціально створеної бази даних: вік, стать, тип і підтип МІ, оцінка тяжкості неврологічного дефіциту за інсультною шкалою Національних інститутів здоров'я (National Institutes of Health Stroke Scale (NIHSS)) та обмеження життєдіяльності за модифікованою шкалою Ренкіна (мШР). Відповідно до загальної оцінки за NIHSS виділено такі градації тяжкості МІ: легкий (0-5 балів), помірної тяжкості (6-13 балів), тяжкий (14-20 балів), дуже тяжкий (>20 балів) [22,23].…”

Section: матеріали та методи вибірка та умови проведення дослідженняunclassified

Determining ischemic stroke subtype: an improved algorithm and its use in a comprehensive stroke unit

Flomin

2023

Ukr. ìnterv. nejroradìol. hìr.

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Objective ‒ to implement a inified algorithm for determining an ischemic cerebral stroke (ICS) etiological subtype and evaluate the results of its use in patients who were admitted to a comprehensive stroke unit (CSU).Materials and methods. The study enrolled 689 patients with ICS (43.4 % women, 56.6 % men; median age 68.1 years (59.7–75.5)) who in 2010 to 2018 were admitted to a hospital unit where the structure and processes correspond to the principles of CSU. The participants’ age, gender, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were analyzed. All patients underwent an initial workup that included neuroimaging, vascular imaging, a cardiologist’s exam and a set of laboratory tests, and an advanced evaluation, at his physician discretion. All ICS was assigned to one of the four etiological subtypes: cardioembolic, atherosclerotic, lacunar or other. Results. According to the proposed algorithm, 294 (42.7 %) cases were assigned to cardioembolic subtype, 282 (40.9 %) to atherosclerotic subtype, 52 (7.5 %) to lacunar subtype and 61 (8.9 %) to ischemic cerebral stroke unknown etiology. Differences in the shown frequency of the main etiological ICS subtypes compared to the results of epidemiological studies are due to the greater severity of ICS in our sample: baseline median NIHSS total score was 10 (6–17), and median modified Rankin scale score was 4 (3–5), and, on the other hand, to in-depth assessment using modern diagnostic technologies and a longer length of stay that allowed for the tests to be completed.Conclusions. Thorough evaluation and the use of a unified algorithm based on causal etiological classifications allow to successfully determine an ICS subtype in the CSU patients with low proportion of ICS of unknown etiology, which is the key to effective secondary prevention.

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“…Considering the fact that there is no "gold standard" or universally recognized diagnostic criteria for SAP yet, the diagnosis of SAP was established by a pulmonologist or a internal medicine specialist based on clinical manifestations and the results of investigations (e.g., chest X-ray or multidetector spiral computer tomography), in accordance with the recommendations of the Centers for Disease Control and Prevention (Horan et al, 2008). According to the NIHSS total score, all cases were divided into mild (0-5), moderate (6-13), severe (14-20) and very severe (more than 20) CS (Zhuo et al, 2021). CS phases, depending on the time elapsed from the estimated CS onset to SC admission, were classified as hyperacute (0-24 hours), acute (1-7 days), early subacute (8 to 90 days), late subacute (91 to 180 days) and chronic (after 180 days) (Bernhardt et al, 2017).…”

Section: Aimmentioning

confidence: 99%

“…Previous studies have shown that SAP is associated with worse neurological and functional recovery and more than triples the risk of death (Armstrong & Mosher, 2011;Ingeman et al, 2011;Yuan et al, 2021). Despite the fact that reducing the risk of SAP could have a significant impact on CS outcome, effective medical (in particular, with antimicrobial agents) prevention of SAP has not yet been developed, and the risk factors of SAP in different periods of the disease have not been sufficiently studied (Grossmann et al, 2021;Liu et al, 2016;Zheng et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

Flomin

Honchar²

2023

USMYJ

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stroke is one of the leading causes of death and acquired disability among adults worldwide. Various complications frequently occur in patients with stroke and can significantly increase the risk for poor outcomes. Stroke-associated pneumonia, with the rate of up to 15%, is considered the most common serious medical complication in stroke patients. The aim of the study was to determine the independent predictors of the stroke-associated pneumonia in patients admitted to a comprehensive stroke unit at different time from stroke onset, as well as to develop a prognostic model for stroke-associated pneumonia risk estimation. Medical complications, including stroke-associated pneumonia, were documented in patients with clinical diagnosis of intraparenchymal cerebral stroke at admission and during their stay on the comprehensive stroke unit in 2010 to 2018. The workup at admission included assessment using the National Institutes of Health Stroke Scale and the modified Rankin scale. The diagnosis of stroke-associated pneumonia was made by specialists, in accordance with Centers for Disease Control recommendations. Qualitative variables are displayed as numbers and percentages, quantitative variables are displayed using the median (interquartile range). The method of logistic regression models was used to quantitatively assess the impact of characteristics on the PSP risk. The analysis was carried out using the package MedCalc v. 19.1. The study enrolled 539 patients, 309 (57.3%) men and 230 (42.7%) women. Median age of the patients was 66.0 years (57.9-75.1). Among the participants 101 (18.7%) were diagnosed with intracerebral hemorrhage, and 438 (81.3%) were diagnosed with ischemic stroke. Median initial National Institutes of Health Stroke Scale total score was 11 (6–18), median baseline modified Rankin scale score was 4 (3–5). Majority (64.1%) individuals were admitted within the first 30 days from onset, while 194 (35.9%) patients presented later. History of medical complications before the admission was present in 192 (35.6%) of the study participants, while during our in-hospital stay they occurred in 103 (19.1%) of the patients. The rate of new medical complications at the unit was significantly lower (p<0.001) than prior to the admission. The diagnosis of stroke-associated pneumonia before the admission was established in 20 (3.7%), and during our in-patient treatment was made in 7 (1.3%) subjects (p<0.001). Independent predictors of the stroke-associated pneumonia development were older age (odds ratio 1.11; 95% confidence interval 1.02-1.21, on average, for each additional year, p=0.02) and history of stroke-associated pneumonia at admission (odds ratio 12.2; 95 % confidence interval 2.0-72.4, p=0.006). Excellent sensitivity (85.7%), good specificity (75.0%) and area under the operating characteristic curve of 0.86 (95% confidence interval 0.83 – 0.89) for the developed prognostic model based on these of two variables, indicate their strong association with the risk of stroke-associated pneumonia during a comprehensive stroke unit stay. Therefore, stroke patients frequently develop medical complications at various stroke phases. The risk of stroke-associated pneumonia is higher in older patients and, especially, in those with stroke-associated pneumonia history. The lower rate of medical complications, in particular stroke-associated pneumonia, observed during in-hospital stay compared to the period prior to the admission may indicate the benefits of comprehensive stroke unit.

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Estimation of stroke severity with National Institutes of Health Stroke Scale grading and retinal features

Cited by 12 publications

References 35 publications

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

Determining ischemic stroke subtype: an improved algorithm and its use in a comprehensive stroke unit

Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

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