title: Role of emergent chest radiography in evaluation of hyperacute stroke.
abstract: OBJECTIVE
  To use data from a large multicenter trial to assess the role and significance of chest radiograph (CXR) in the initial evaluation of acute stroke.
  
  
  METHODS
  Predefined clinical characteristics of patients who had recorded data on CXR examination during the initial evaluation were collected. We compared features of patients who had a CXR done before IV thrombolytics with those who did not. Rates of adverse cardiopulmonary events, intubation, and in-hospital mortality were also compared. Logistic regression analysis was performed to evaluate for the association of CXR performance with door-to-needle time ≥60 minutes.
  
  
  RESULTS
  In a cohort of 615 patients, 243 had CXR done before IV thrombolytics. Patients with CXR before treatment had significantly higher admission neurologic deficit, initial respiratory rates, and door-to-needle time than those with CXR after treatment. The rates of cardiopulmonary adverse events in the first 24 hours of admission, endotracheal intubation in the first 7 hours, and in-hospital mortality were not different between the 2 groups. Patients with CXR done before treatment had longer mean door-to-needle times than those without pretreatment radiography (75.8 vs 58.3 minutes, p = 0.0001). Performance of CXR was independently associated with door-to-needle time ≥60 minutes (odds ratio 2.78, 95% confidence interval 1.97-3.92; p = 0.00001).
  
  
  CONCLUSIONS
  Performance of CXR prior to IV thrombolytics prolongs door-to-needle time in acute ischemic stroke patients. CXR before treatment should be reserved for situations wherein acute cardiopulmonary conditions would otherwise preclude the administration of IV thrombolytics or substantially influence management.
authors.affiliation: From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Saber
authors.affiliation: From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
authors.affiliation: From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Santillan
authors.affiliation: From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Mahmoud R
authors.initials: MR
authors.lastname: Azarpazhooh
authors.affiliation: From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Vivek
authors.initials: V
authors.lastname: Misra
authors.affiliation: From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Behrouz@uthscsa.edu.
authors.forename: Réza
authors.initials: R
authors.lastname: Behrouz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator