Functional status at 30 and 90 days after mild ischaemic stroke.
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2022-04
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Abstract
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This study compares the global disability status of patients who had a mild ischaemic stroke at 30 and 90 days poststroke, as measured by the modified Rankin Scale (mRS), and identifies predictors of change in disability status between 30 and 90 days.Methods
The study population included 1339 patients who had a ischaemic stroke enrolled in the Mild and Rapidly Improving Stroke Study with National Institutes of Health (NIH) stroke score 0-5 and mRS measurements at 30 and 90 days. Outcomes were (1) Improvement defined as having mRS >1 at 30 days and mRS 0-1 at 90 days OR mRS >2 at 30 days and mRS 0-2 at 90 days and (2) Worsening defined as an increase of ≥2 points or a worsening from mRS of 1 at 30 days to 2 at 90 days. Demographic and clinical characteristics at hospital arrival were abstracted from medical records, and regression models were used to identify predictors of functional improvement and decline from 30 to 90 days post-stroke. Significant predictors were mutually adjusted in multivariable models that also included age and stroke severity.Results
Fifty-seven per cent of study participants had no change in mRS value from 30 to 90 days. Overall, there was moderate agreement in mRS between the two time points (weighted kappa=0.59 (95% CI 0.56 to 0.62)). However, worsening on the mRS was observed in 7.54% of the study population from 30 to 90 days, and 17.33% improved. Participants of older age (per year OR 1.02, 95% CI 1.00 to 1.03), greater stroke severity (per NIH Stroke Scale (NIHSS) point at admission OR 1.17, 95% CI 1.03 to 1.34), and those with no alteplase treatment (OR 1.72, 95% CI 1.11 to 2.69) were more likely to show functional decline after mutual adjustment.Discussion
A quarter of all mild ischaemic stroke participants exhibited functional changes between 30 and 90 days, suggesting that the 30-day outcome may insufficiently represent long-term recovery in mild stroke and longer follow-up may be clinically necessary.Trial registration number
NCT02072681.Type
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Gardener, Hannah, Leo A Romano, Eric E Smith, Iszet Campo-Bustillo, Yosef Khan, Sofie Tai, Nikesha Riley, Ralph L Sacco, et al. (2022). Functional status at 30 and 90 days after mild ischaemic stroke. Stroke and vascular neurology, 7(5). p. svn-2021-001333. 10.1136/svn-2021-001333 Retrieved from https://hdl.handle.net/10161/27473.
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Brian C. Mac Grory
Dr. Brian Mac Grory, MB BCh BAO, MHSc, MRCP, FAHA, FANA is an Associate Professor of Neurology & Ophthalmology at the Duke University School of Medicine and a Staff Neurologist at Duke University Medical Center. He received his medical degree from University College Dublin in Dublin, Ireland in 2011. After an internship at St. Vincent's University Hospital, Dublin, he completed a neurology residency and vascular neurology fellowship at the Yale School of Medicine/Yale-New Haven Hospital in New Haven, Connecticut. Upon completion of his training, he served for 3 years on the faculty of Brown University/Rhode Island Hospital before being recruited to Duke University in 2020.
His clinical practice encompasses both vascular and general neurology in the emergency, inpatient, outpatient, and telemedicine settings. He has a particular clinical interest in central retinal artery occlusion (CRAO or "eye stroke") and has developed a center of excellence for the treatment of this condition at Duke. He led the development of the first ever American Heart Association (AHA) scientific consensus statement on the management of CRAO which was endorsed by six professional medical societies in the United States representing neurology, neurosurgery, cardiology, ophthalmology, neuro-ophthalmology, and optometry.
Dr. Mac Grory has published over 100 peer-reviewed scientific articles appearing in JAMA, British Medical Journal, Circulation, Stroke, Annals of Neurology, JAMA Neurology, and Neurology. His research on retinal vascular disease is funded by the National Institutes of Health/National Heart, Lung, and Blood Institute (K23 HL161426), the AHA (23MRFSCD1077188), and the Duke Office of Physician-Scientist Development (FRCS #2835124). Additionally, he serves as Clinical Lead for the Get With The Guidelines-Stroke Data Analytic Program at the Duke Clinical Research Institute (DCRI) and Associate Program Director for the vascular neurology fellowship program at Duke. His research has been recognized with the Stroke Progress and Innovation Award, Stroke Care in Emergency Medicine Award, and Early Career Investigator Award from the AHA/American Stroke Association. He is a member of the AHA's Stroke Systems of Care Advisory Group, the Stroke Emergency Neurovascular Care Committee, and the Royal College of Physicians of the United Kingdom (MRCP(UK)).
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