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Table of Contents
Vol. 29, No. 1, 2010
Issue release date: December 2009
Section title: Original Paper
Cerebrovasc Dis 2010;29:50–56
(DOI:10.1159/000255974)

Day-90 Acute Ischemic Stroke Outcomes Can Be Derived from Early Functional Activity Level

Ovbiagele B. · Saver J.L.
Stroke Center and Department of Neurology, UCLA Medical Center, and Department of Neurology, Olive View – UCLA Medical Center, Los Angeles, Calif., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/11/2009
Accepted: 8/12/2009
Published online: 11/5/2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 5

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: The time point generally recognized as most appropriate to assess final functional outcome after acute ischemic stroke is 3 months. However, identifying earlier reliable prognostic time points may allay patient anxiety about the recovery process, enable assignment of outcome in patients lost to follow-up, and provide earlier and more readily available options for clinical outcome assessment in adaptive design and proof of concept studies. We assessed whether day-7/10 functional outcome predicted day-90 functional outcome among acute ischemic stroke patients. Methods: The NINDS-tPA Study database was analyzed. Global disability was assessed using the modified Rankin Scale (mRS). Spearman correlation evaluated the association of day-7/10 versus day-90 mRS, and observed agreement was computed using the weighted κ agreement, both unadjusted and adjusted by multivariable ordinal logistic modeling for demographic and clinical variables known to influence stroke outcomes. Results: 581 subjects (93%) were alive at 7–10 days. There was strong correlation between mRS score at day 7/10 and day 90 (r = 0.81, p < 0.0001), and the weighted κ agreement was 0.82 (p < 0.0001). In multivariable analysis, day-7/10 day mRS was independently and strongly associated with day-90 mRS, while among other baseline variables, only baseline NIH Stroke Scale score (per unit increase) and a history of congestive heart failure (CHF) were significantly associated with a worse day-90 mRS. Conclusions: Global disability status 1 week after an index ischemic stroke strongly predicts final 3-month disability outcome. Functioning at 1 week, supplemented by initial stroke severity and CHF history information, may provide an early outcome guide useful for patient and family counseling.


  

Author Contacts

Bruce Ovbiagele, MD, MS
Stroke Center and Department of Neurology, University of California at Los Angeles
710 Westwood Plaza
Los Angeles, CA 90095 (USA)
Tel. +1 310 794 6379, Fax +1 310 267 2063, E Mail ovibes@mednet.ucla.edu

  

Article Information

Received: March 11, 2009
Accepted: August 12, 2009
Published online: November 5, 2009
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 5, Number of References : 23

  

Publication Details

Cerebrovascular Diseases

Vol. 29, No. 1, Year 2010 (Cover Date: December 2009)

Journal Editor: Hennerici M.G. (Mannheim)
ISSN: 1015-9770 (Print), eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/11/2009
Accepted: 8/12/2009
Published online: 11/5/2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 5

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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