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Findings help predict stroke outcomes

Quality Improvement Monitor, October 26, 2004

Stroke patients are more likely to experience poor outcomes or death at three months if they show little improvement in the first 24 hours after receiving clot-dissolving therapy. Other factors, including elevated blood glucose levels, and time to treatment, can also predict a patient's lack of improvement, according to new research.

The research, published October 20 in the Journal of the American Medical Association, sheds light on the clinical factors that influence the recovery and clinical response to clot-dissolving therapy, or thrombolytic, therapy. This could help clinicians predict poor outcomes much sooner (24 hours after receiving the therapy) and would have important implications for clinical management and discharge planning.

Gustavo Saposnik, MD, of the University of Western Ontario, in London, Canada, and colleagues examined predictors of lack of improvement at 24 hours after receiving alteplase (clot-disolving drug) and their relationship with poor outcomes at three months. The study included 216 acute stroke patients who received alteplase and were admitted to a university hospital from January 1999 to March 2003. Participants were recruited from two academic centers in a major city in Ontario and 33 affiliated hospitals from seven counties.

They found that 111 (51%) of the patients had not improved within 24 hours. After adjusting for age, sex, and stroke severity, independent predictors of lack of improvement included elevated glucose level on admission (a nearly three times greater risk); cerebral cortex involvement (a 2.6 times greater risk); and time to treatment.

At three months, 43 patients (20%) had died. Among the 170 survivors, 75 patients (44%) had poor outcomes. After adjusting for age, sex, and stroke severity, lack of improvement at 24 hours was an independent predictor of poor outcomes (nearly 13 times more likely) and death (eight times more likely). Patients with a lack of improvement had longer lengths of hospitalization (14.5 vs. 9.6 days).

"Our study adds a useful perspective concerning early prediction of outcome by introducing a clinical variable (lack of improvement) that can be easily measured. Its recognition can contribute to the management of patients with stroke after thrombolytic therapy with alteplase in terms of early prediction of outcome," the authors write.

-- Wendy Johnson
wjohnson@hcpro.com

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