Prediction of Functional Outcome in Patients With Primary Intracerebral Hemorrhage

Rost, Natalia S.; Smith, Eric E.; Chang, Yuchiao; Snider, Ryan W.; Chanderraj, Rishi; Schwab, Kristin; FitzMaurice, Emily; Wendell, Lauren; Goldstein, Joshua N.; Greenberg, Steven M.; Rosand, Jonathan

doi:10.1161/strokeaha.107.512202

Cited by 399 publications

(346 citation statements)

References 43 publications

Supporting

Mentioning

323

Contrasting

Unclassified

Order By: Relevance

“…320, 326 The proportion of patients dying, surviving in a dependent or independent state after stroke according to the Rankin score, by age of patient, was taken from the LSR 327,328 and the ESS. 111 A Rankin score of '0-2' indicates independent survival, '3-5' indicates survival in a dependent state, and '6' is dead.…”

Section: Long-term Outcomes After Strokementioning

confidence: 99%

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

View full text Add to dashboard Cite

BackgroundPatients with transient ischaemic attack (TIA) or minor stroke need rapid treatment of risk factors to prevent recurrent stroke. ABCD2 score or magnetic resonance diffusion-weighted brain imaging (MR DWI) may help assessment and treatment.ObjectivesIs MR with DWI cost-effective in stroke prevention compared with computed tomography (CT) brain scanning in all patients, in specific subgroups or as ‘one-stop’ brain-carotid imaging? What is the current UK availability of services for stroke prevention?Data sourcesPublished literature; stroke registries, audit and randomised clinical trials; national databases; survey of UK clinical and imaging services for stroke; expert opinion.Review methodsSystematic reviews and meta-analyses of published/unpublished data. Decision-analytic model of stroke prevention including on a 20-year time horizon including nine representative imaging scenarios.ResultsThe pooled recurrent stroke rate after TIA (53 studies, 30,558 patients) is 5.2% [95% confidence interval (CI) 3.9% to 5.9%] by 7 days, and 6.7% (5.2% to 8.7%) at 90 days. ABCD2 score does not identify patients with key stroke causes or identify mimics: 66% of specialist-diagnosed true TIAs and 35–41% of mimics had an ABCD2 score of ≥ 4; 20% of true TIAs with ABCD2 score of < 4 had key risk factors. MR DWI (45 studies, 9078 patients) showed an acute ischaemic lesion in 34.3% (95% CI 30.5% to 38.4%) of TIA, 69% of minor stroke patients, i.e. two-thirds of TIA patients are DWI negative. TIA mimics (16 studies, 14,542 patients) make up 40–45% of patients attending clinics. UK survey (45% response) showed most secondary prevention started prior to clinic, 85% of primary brain imaging was same-day CT; 51–54% of patients had MR, mostly additional to CT, on average 1 week later; 55% omitted blood-sensitive MR sequences. Compared with ‘CT scan all patients’ MR was more expensive and no more cost-effective, except for patients presenting at > 1 week after symptoms to diagnose haemorrhage; strategies that triaged patients with low ABCD2 scores for slow investigation or treated DWI-negative patients as non-TIA/minor stroke prevented fewer strokes and increased costs. ‘One-stop’ CT/MR angiographic-plus-brain imaging was not cost-effective.LimitationsData on sensitivity/specificity of MR in TIA/minor stroke, stroke costs, prognosis of TIA mimics and accuracy of ABCD2 score by non-specialists are sparse or absent; all analysis had substantial heterogeneity.ConclusionsMagnetic resonance with DWI is not cost-effective for secondary stroke prevention. MR was most helpful in patients presenting at > 1 week after symptoms if blood-sensitive sequences were used. ABCD2 score is unlikely to facilitate patient triage by non-stroke specialists. Rapid specialist assessment, CT brain scanning and identification of serious underlying stroke causes is the most cost-effective stroke prevention strategy.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Long-term Outcomes After Strokementioning

confidence: 99%

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…4,10,29,34,38,41 Patients with ICH suffer from additional brain injury caused by increased intracranial pressure (ICP), which requires prompt intervention to prevent devastating neurological outcomes.…”

mentioning

confidence: 99%

Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage

Kim

Park²,

Kang

et al. 2014

JNS

View full text Add to dashboard Cite

Object. Mannitol, an osmotic agent used to decrease intracranial pressure, can cause acute kidney injury (AKI). The objectives of this study were to assess the impact of mannitol on the incidence and severity of AKI and to identify risk factors and outcome for AKI in patients with intracranial hemorrhage (ICH).Methods. The authors retrospectively evaluated 153 adult patients who received mannitol infusion after ICH between January 2005 and December 2009 in the neurosurgical intensive care unit. Multivariate analysis was used to evaluate the risk factors for AKI after ICH. Based on the odds ratio, weighted scores were assigned to predictors of AKI.Results. The overall incidence of AKI among study participants was 10.5% (n = 16). Acute kidney injury occurred more frequently in patients who received mannitol infusion at a rate ≥ 1.34 g/kg/day than it did in patients who received mannitol infusion at a rate < 1.34 g/kg/day. A higher mannitol infusion rate was associated with more severe AKI. Independent risk factors for AKI were mannitol infusion rate ≥ 1.34 g/kg/day, age ≥ 70 years, diastolic blood pressure (DBP) ≥ 110 mm Hg, and glomerular filtration rate < 60 ml/min/1.73 m 2 . The authors developed a risk model for AKI, wherein patients with a higher risk score showed a graded association with a higher incidence of AKI.Conclusions. The incidence of AKI following mannitol infusion in patients with ICH was 10.5%. A higher mannitol infusion rate was associated with more frequent and more severe AKI. Additionally, age ≥ 70 years, DBP ≥ 110 mm Hg, and established renal dysfunction before starting mannitol therapy were associated with development of AKI. (http://thejns.org/doi/abs/10.3171/2013.12.JNS13888) KeY WorDs • acute kidney injury • intracranial hemorrhage • mannitol • vascular disordersAbbreviations used in this paper: AKI = acute kidney injury; AKIN = Acute Kidney Injury Network; AUC = area under the curve; DBP = diastolic blood pressure; GFR = glomerular filtration rate; ICH = intracranial hemorrhage; ICP = intracranial pressure; IQR = interquartile range; ROC = receiver operating characteristic; SBP = systolic blood pressure.

show abstract

“…In addition, it predicts poor functional outcome [13,14]. The apolipoprotein E ε2 allele is associated with larger hematomas, which appears to explain its effect on outcome [15].…”

Section: Initial Hematomamentioning

confidence: 98%

“…The FUNC score predicts functional independence at 3 months and uses age, premedical history of cognitive impairment, GCS score, ICH location, and ICH volume (Fig. 3) [14].…”

Section: Outcome Predictionmentioning

confidence: 99%

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers

Goldstein

2012

Neurotherapeutics

Self Cite

View full text Add to dashboard Cite

Prediction of Functional Outcome in Patients With Primary Intracerebral Hemorrhage

Cited by 399 publications

References 43 publications

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Contact Info

Product

Resources

About