Stroke; a journal of cerebral circulation
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Comparative Study
An admission bioclinical score to predict 1-year outcomes in patients undergoing aneurysm coiling.
A number of scores were developed to predict outcomes after clipping for subarachnoid hemorrhages, yet there is no score for patients undergoing endovascular treatment. Our goal was to develop, compare, and validate a predictive score for 1-year outcomes in patients with coiled subarachnoid hemorrhage. ⋯ The ABC score improves 1-year outcome prediction at admission for patients with coiled subarachnoid hemorrhage. Our study provides large cohort-based evidence supporting integration of individual biomarkers and clinical characteristics to predict outcomes. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01357057.
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Multicenter Study Comparative Study
Proportion of patients treated with thrombolysis in a centralized versus a decentralized acute stroke care setting.
Today, treatment of acute stroke consists of tissue-type plasminogen activator (tPA), admission to a stroke unit, and aspirin. Although tPA treatment is the most effective, there is substantial undertreatment. Centralized care may affect rate, timing, and outcome of thrombolysis compared to decentralized treatment in community hospitals. The present study aimed to assess the impact of organizational models on the proportion of patients undergoing tPA treatment. ⋯ In a centralized setting, the results demonstrate a 50% increased likelihood of treatment. Prehospital factors seem to contribute to this result.
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National guidelines recommend patients with acute stroke undergo brain imaging within 25 minutes of emergency department arrival. Delayed brain imaging may reduce the effectiveness of thrombolysis or render patients ineligible. ⋯ Most patients with acute stroke symptoms do not have brain imaging performed within the recommended 25 minutes. Future quality improvement initiatives should focus on reducing door-to-imaging times with a specific emphasis on the predictive variables identified in this analysis.
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Lactate is central for the regulation of brain metabolism and is an alternative substrate to glucose after injury. Brain lactate metabolism in patients with subarachnoid hemorrhage has not been fully elucidated. ⋯ Brain lactate is frequently elevated in subarachnoid hemorrhage patients, predominantly because of hyperglycolysis rather than hypoxia. A pattern of increased cerebral hyperglycolytic lactate was associated with good long-term recovery. Our data suggest that lactate may be used as an aerobic substrate by the injured human brain.