Abstract
Background Stroke is a leading cause of death and disability in developed countries. The major factor affecting long-term survival other than age is the disability severity caused by stroke. The modified Rankin Scale (mRS) is a global functional endpoint measurement used in acute stroke to evaluate the degree of disability or dependence in daily life activities. The objective of this study was to assess the effects of sociodemographic factors, concomitant disease states, and some measures performed in the emergency department (ED) on patients' disability. Methods We conducted a retrospective study on ischemic stroke patients admitted to Intensive Care Unit of three Lebanese university hospitals between June and December 2016. Patients were excluded if they had been discharged from ED without hospital admission or if mRS was not performed. The mRS was further subdivided into two categories considered as “good prognosis” (0-2 or 0-3) and “poor prognosis” (>2 or > 3). Results 204 patients were included in the study with mean age of 65.4 ± 11.9 years, hypertension was the most previous concomitant past medical disease (77.1%), and 27.1% of these patients had previous history of stroke. No significant differences were found in both mRS categories for all sociodemographic factors, and past medical history except that arrhythmia was significantly more common in the higher mRS categories > 2 and > 3. Based on multivariable analysis, there was a trend for previous intake of calcium channel blocker to be associated with lower mRS at admission (beta -0.586). However, intracranial arterial stenosis, ED blood glucose > 180 mg/dL, and performing brain imaging above 20 minutes after patient presentation to ED were significantly associated with higher mRS scores at discharge with an ORa and (confidence interval) of 2.986 (0.814, 10.962), 3.301 (1.072, 1.261), and 1.138 (1.071, 9.080), respectively. Conclusion mRS is affected by previous disease states, prescribed medications, and acute measures performed in ED. It is also influenced by intracranial arterial stenosis etiology, which is associated with worse outcome.
Highlights
Stroke is the third leading cause of mortality after heart diseases and cancer and a principal cause of severe long-term disability in adults [1]
55.4% were on beta blockers, 34% were on calcium channel blockers (CCBs), and 25.3% were on dual antihypertensive drugs
To the best of our knowledge, this is the first study that evaluates the association between sociodemographic factors, concomitant disease states, and some blood and imaging measures performed in the emergency department on the modified Rankin Scale score in a sample of Lebanese stroke patients
Summary
Stroke is the third leading cause of mortality after heart diseases and cancer and a principal cause of severe long-term disability in adults [1]. MRS is a global functional endpoint measurement and the most frequently used index in acute stroke to evaluate the degree of disability or dependence in daily life activities following stroke and thereby communicate effects of treatments to physicians and patients [4, 5]. This scale is a standard element in clinical practice and an outcome measure that must be used in all stroke survivors according to the Get with the Guidelines [6]. MRS is affected by previous disease states, prescribed medications, and acute measures performed in ED It is influenced by intracranial arterial stenosis etiology, which is associated with worse outcome
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