Presenting Symptoms and Dysphagia Screen Predict Outcome in Mild and Rapidly Improving Acute Ischemic Stroke Patients.
OBJECTIVE
There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes.


METHODS
Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home.


RESULTS
There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, <1% of patients presenting to participating hospitals with MaRISS within the eligible time window received IV tPA.


CONCLUSIONS
Baseline characteristics, presenting symptoms, and response to dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial.
Emory University School of Medicine, Atlanta, US.
Gaurav
G
Gadodia
Lebanese American University Medical Center, Beirut, Lebanon.
Nibal
N
Rizk
Piedmont Newnan Hospital, Piedmont Healthcare, Atlanta, US.
Deborah
D
Camp
Northside Hospital, Atlanta, US.
Katja
K
Bryant
WellStar Kennestone Hospital, Atlanta, US.
Susan
S
Zimmerman
Emory University Hospital, Atlanta, US.
Cynthia
C
Brasher
Genentech, San Francisco, US.
Kerrin
K
Connelly
Emory University Hospital, Atlanta, US.
Joshua
J
Dunn
Department of Neurology, Emory University, Atlanta, US.
Michael
M
Frankel
Georgia Department of Public Health, Atlanta, US.
Moges Seymour
MS
Ido
Georgia Department of Public Health, Atlanta, US.
James
J
Lugtu
Department of Neurology & Pediatrics, Emory University, Atlanta, US. Electronic address: fnahab@emory.edu.
Fadi
F
Nahab
D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
Acute stroke treatment; Dysphagia screen; MaRISS; Minor stroke; Thrombolysis