Initial Clinical Severity Research Articles

Associations with health-related quality of life after intracerebral haemorrhage: pooled analysis of INTERACT studies

Background and purposeLimited data exist on health-related quality of life (HRQoL) after intracerebral haemorrhage (ICH). We aimed to determine baseline factors associated with HRQoL among participants of the pilot and...

Cyclophilin A in Ruptured Intracranial Aneurysm: A Prognostic Biomarker.

Cyclophilin A (CyPA), an oxidative stress-induced factor, was found to play an important role in the aneurysm formation. Our working hypothesis was that the plasma level of CyPA in ruptured intracranial aneurysm could predict the neurological outcome.From 2011 to 2013, a total of 36 patients with ruptured saccular intracranial aneurysm were recruited in our study. Before coil embolization, we draw blood samples at the orifice of a culprit aneurysm and in the remote peripheral vein for measurements of the CyPA levels. We utilized the modified Rankin scale 30 days after aneurysm rupture as the outcome measure. Generalized linear models were used to estimate the adjusted odds ratios of the poor neurological outcome given the presence of high plasma level of CyPA.The aneurysmal and venous CyPA levels were significantly associated with the initial clinical severity (P = 0.004 and 0.03, respectively) and 30-day outcome (P = 0.01 and 0.02, respectively). The aneurysmal CyPA levels modestly correlated with age and high Fisher grade (ρ = 0.39 and 0.41; P = 0.02 and 0.01, respectively). The aneurysmal CyPA levels strongly correlated with the venous counterpart (ρ = 0.89; P < 0.001). Patients with high levels of aneurysmal CyPA were 15.66 times (95% CI, 1.48–166.24; P = 0.02) more likely to have worse neurological outcome than those with the low levels after adjustment of the age, gender, and the documented confounding factors.High plasma level of CyPA is a significant prognostic biomarker for poor neurological outcome in patients with ruptured intracranial aneurysm.

Coherent neural oscillations predict future motor and language improvement after stroke.

Recent findings have demonstrated that stroke lesions affect neural communication in the entire brain. However, it is less clear whether network interactions are also relevant for plasticity and repair. This study investigated whether the coherence of neural oscillations at language or motor nodes is associated with future clinical improvement. Twenty-four stroke patients underwent high-density EEG recordings and standardized motor and language tests at 2-3 weeks (T0) and 3 months (T1) after stroke onset. In addition, EEG and motor assessments were obtained from a second population of 18 stroke patients. The graph theoretical measure of weighted node degree at language and motor areas was computed as the sum of absolute imaginary coherence with all other brain regions and compared to the amount of clinical improvement from T0 to T1. At T0, beta-band weighted node degree at the ipsilesional motor cortex was linearly correlated with better subsequent motor improvement, while beta-band weighted node degree at Broca's area was correlated with better language improvement. Clinical recovery was further associated with contralesional theta-band weighted node degree. These correlations were each specific to the corresponding brain area and independent of initial clinical severity, age, and lesion size. Findings were reproduced in the second stroke group. Conversely, later coherence increases occurring between T0 and T1 were associated with less clinical improvement. Improvement of language and motor functions after stroke is therefore associated with inter-regional synchronization of neural oscillations in the first weeks after stroke. A better understanding of network mechanisms of plasticity may lead to new prognostic biomarkers and therapeutic targets.See Ward (doi:10.1093/brain/awv265) for a scientific commentary on this article.

Guillain-Barre Syndrome Associated with Rapid Immune Reconstitution Following a Tandem Autologous Hematopoietic Stem Cell Transplantation. Study of a Case and Review of the Literature

Introduction: Guillain-Barre syndrome (GBS) is a frequent cause of neuromuscular paralysis and usually occurs after an immunoallergic reaction, most often after respiratory or gastrointestinal infection. However, rare cases of Guillain-Barre syndrome are described, associated with hematopoietic stem cell transplantation. Observation: Patient n° 20452690. The authors report the case of 21 years old man, treated for Hodgkin lymphoma with a recurrence at 18 months, who enjoyed second autologous hematopoietic stem cell transplantation after conditioning chemotherapy, then developed a Guillain-Barre syndrome. Plasma exchanges were made before a neurological worsening. Thereafter, five cycles of intravenous immunoglobulin were performed monthly. Unfortunately this development was hampered by mechanical respiratory complication that led to the death of the patient, the 237th day of evolution. The final diagnosis of Guillain-Barre syndrome, occurred in a context of post-transplant immune reconstitution in a patient treated for Hodgkin lymphoma was retained. Discussion: GBS is a rare complication of hematopoietic stem cell transplantation. After literature review, we collected 33 cases related to this disease, 10 occurred after autograft. Etiopathogenic mechanisms remain obscure. Despite the use of immunomodulatory treatment, the prognosis is often severe and dark. Conclusion: GBS is possible after autologous hematopoietic stem cell transplantation indicated for the treatment of Hodgkin lymphoma. The initial clinical severity, despite safeguards and use of immunomodulatory therapy, will cause often deleterious and poor outcome. To our knowledge, this well documented observation is the first case indicated for Hodgkin lymphoma.

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

We aimed to investigate the impact of smoking status on clinical severity in patients with ischemic stroke event (IS). Patients were prospectively identified among residents of the city of Dijon, France (ca. 151,000 inhabitants), using a population-based registry, between 2006 and 2011. Demographic and clinical data were recorded. The initial clinical severity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multivariable ordinal logistic regression was used to assess the effect of smoking status on severity. Among the 1,056 recorded patients with IS, data about smoking status were available for 973 (92.1%), of whom 658 (67.3%) were non-smokers, 187 (19.2%) were current smokers, and 128 (13.2%) were former smokers. Compared with non-smoking, former smoking was associated with less severe IS (OR 0.55; 95% CI 0.38-0.82, p = 0.003), whereas this association was not found for current smokers (OR 0.97; 95% CI 0.69-1.36, p = 0.856). Further work is needed to understand the underlying mechanisms of this finding.

Abstract TP59: Clinical Course and Radiological Outcome of Mild Stroke Patients Treated and not Treated with Thrombolysis

Background: Around 30% of patients with acute stroke are excluded from thrombolysis because of mild or improving symptoms, but some of these patients don’t achieve a good recovery. We compared the clinical and radiological course in a cohort of 239 patients with mild stroke treated and not treated with thrombolysis in the same institution. Methods: We studied all patients with ischemic stroke admitted within 6 hours of symptom-onset with previous mRS≤1 and mild symptoms (NIHSS≤5) at arrival or during initial evaluation. We compared the baseline characteristics, clinical course (NIHSS), radiological outcome (final DWI lesion volume), incidence of symptomatic intracranial hemorrhage (sICH) and favourable 3-month outcome (mRS≤1) of patients treated with thrombolysis (123 tPA only and 9 endovascular interventions) or not treated (n=107). Results: Treated patients had greater clinical severity at presentation and after imaging and arrived to the hospital faster than not treated patients. In a general linear model of repeated measures, their course was significantly different (p=0.03) and thrombolised patients improved more during hospitalization. Patients with significant neurological improvement (NIHSS score&gt;1) had more severe strokes at presentation but similar outcome, and were more often treated with tPA (p&lt;0.001). Infarct volume was significantly correlated with NIHSS score especially at day 1. Despite the differences in the initial clinical severity, final infarct volume was similar in treated and not treated patients. The rate of sICH was similar in both groups. Outcome at 3-months was associated to past history of stroke, glucose levels and deterioration during hospital stay. On multivariate analysis, thrombolysis remained associated to neurological improvement (OR 4.34;p&lt;0.001) and was non-significantly associated to greater chances of good functional outcome at 3-months (OR 2.38;p=0.099). Conclusions: In patients with mild stroke thrombolysis was safe and was associated to better neurological course. Overall, these results suggest that patients presenting with mild symptoms do benefit from thrombolysis.

Oral cyclophosphamide without corticosteroids to treat mucous membrane pemphigoid

Mucous membrane pemphigoid (MMP) still represents a potentially life- and sight-threatening disease. Immunosuppressants, such as cyclophosphamide (CYC), are indicated for patients with severe and/or refractory MMP. To evaluate the efficacy and safety of daily oral CYC without corticosteroids as therapy for severe MMP. Thirteen patients with severe refractory MMP, who received oral CYC at an initial dose of 2 mg kg(-1) without corticosteroids, were retained. Previous treatments, for example dapsone, sulfasalazine or topical agents, were maintained during CYC treatment. Initial clinical severity and response to treatment were assessed by scoring. CYC was stopped after complete remission (CR), or when MMP progressed or lymphopenia (< 0·7 × 10(9) cells L(-1) ) occurred. After 52 weeks of CYC treatment, the overall response rate was 69% (9/13 patients) with a median time to disease control of 8 weeks (range 4-52 weeks). Seven patients (54%) entered CR with a median time to CR of 24 weeks (range 16-52 weeks), all remaining in CR at week 52. The mean duration of CYC administration was 12 weeks (range 2-52 weeks). The most common side effect was lymphopenia (10/13 patients), which led to CYC withdrawal for six patients. No sepsis was observed. CYC without corticosteroids had rapid efficacy in patients with severe refractory MMP and was safe.

Effect of previous statin therapy on severity and outcome in ischemic stroke patients: a population-based study

Although statin therapy has been shown to be effective in the prevention of ischemic stroke, its effect on stroke severity and early outcome is still controversial. We aimed to evaluate the association between statin use before onset and both initial severity and functional outcome in ischemic stroke patients. All cases of first-ever ischemic stroke that occurred in Dijon, France (151,000 inhabitants) between 2006 and 2011 were prospectively identified from the Dijon Stroke Registry. Vascular risk factors, clinical severity at onset assessed by the NIHSS score, stroke subtypes, prestroke statin use, and lipid profile were collected. Functional outcome was defined by a six-level categorical outcome using the modified Rankin scale. Analyses were performed using ordinal logistic regression models. Among the 953 patients with first-ever ischemic stroke, 127 (13.3 %) had previously been treated with statins. Initial stroke severity did not differ between statin users and non-users [median NIHSS score (interquartile range) 4.0 (7.0) versus 4.0 (9.0) p = 0.104]. In unadjusted analysis, statin use was associated with a lower risk of an unfavorable functional outcome at discharge (OR 0.69; 95 % CI 0.49-0.96; p = 0.026) that was no longer significant in multivariate analyses (OR 0.76; 95 % CI 0.53-1.09; p = 0.134). After adjustment for admission plasma LDL cholesterol levels, the non-significant association was still observed (OR 0.76; 95 % CI 0.49-1.18; p = 0.221). This population-based study showed that prestroke statin therapy did not affect initial clinical severity but was associated with a non-significant better early functional outcome after ischemic stroke.

Cerebral perfusion in acute stroke prognostication

Most patients improve after stroke. But when dealing with individuals, clinicians are challenged to predict whether, how much, and how soon that particular patient will recover. The best predictive tool for at least 40 years has been the presenting clinical examination—the odds and the extent of recovery decrease roughly proportionally to the initial clinical severity.1,2 Newer technologies incorporated into the stroke workup have enabled neurologists to forecast more accurately individual stroke outcomes. Imaging and quantifying the “real estate factor”—infarct location and size—adds some confidence to stroke outcome prediction.3 But how much does this information really tell us that we do not already know from examining the patient? More importantly, can we develop algorithms that not only improve prognostication, but also inform treatment? Enter vascular- and flow-based imaging technologies. Visualizing acute large-vessel occlusion guides the use …

6 cmH2O continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis: A randomized trial

To compare the effects of nasal continuous positive airway pressure (nCPAP) and conventional oxygen therapy on the clinical signs of respiratory distress and the respiratory muscle workload in acute viral bronchiolitis. Prospective, randomized, monocentric study carried out in the pediatric intensive care unit (PICU) of a university hospital. Infants <6 months old, admitted to the PICU with severe respiratory syncytial virus bronchiolitis. The patients were randomized into two groups for 6 hr. The nCPAP group (n = 10) received 6 cmH(2)O pressure support delivered by a jet flow generator and the control group (n = 9) received an air/oxygen mixture from a heated humidifier. Respiratory distress was assessed by the modified Wood's clinical asthma score (m-WCAS), and inspiratory muscle work was evaluated by calculating the pressure-time product per breath (PTP(insp) /breath) and per minute (PTP(insp) /min) from the esophageal pressure (Pes) recordings. Compared with control condition, nCPAP decreased m-WCAS [-2.4 (1.05) vs. -0.5 (1.3), P = 0.03], PTPes(insp)/breath [-9.7 (5.7) vs. -1.4 (8.2), P = 0.04], PTPes(insp) /min [-666 (402) vs. -116 (352), P = 0.015], and FiO(2) [-7 (10) vs. +5 (15), P = 0.05]. Significant worsening of m-WCAS was only observed in the control group (4/9 vs. 0/10, P = 0.03). nCPAP rapidly decreased inspiratory work in young infants with acute bronchiolitis. Improvement in the respiratory distress score at 6 hr was proportional to the initial clinical severity, suggesting the importance of rapid nCPAP initiation in the more severe forms of the disease.

Attachment style predicts 6‐month improvement in psychoticism in persons with at‐risk mental states for psychosis

Insecure attachment may influence vulnerability to and outcome of psychotic symptomatology. The present study examined whether attachment style predicted symptoms and functioning of at-risk mental state (ARMS) patients after 6 months of psychosocial intervention, over and above the effects of initial clinical severity and premorbid social adjustment (PSA). Symptoms and functioning were assessed at baseline and 6 months later in 31 ARMS patients (mean age = 15.7). No patient received antipsychotic medication, but all engaged in intense psychosocial needs-adapted treatment. Clinicians (unaware of the aims of the study) rated attachment, PSA, symptoms, and functioning. Attachment was not related to baseline clinical severity. However, improvement in psychoticism was predicted by attachment (in particular by secure, preoccupied and dismissing) beyond the effects of baseline clinical severity and PSA. Secure attachment also predicted improvements in disorganization and functioning. Poor PSA predicted less improvement in disorganization and negative symptoms but did not impact psychoticism. The three attachment prototypes that predicted improvement in psychoticism (secure, preoccupied and dismissing) share the existence of at least one positive psychological model (either about self or about others). It may be that the psychosocial intervention helped ARMS patients to disconfirm negative models and/or reinforce positive ones. Patients' attachment styles were not related to baseline clinical severity but impacted improvement of positive symptoms. These findings appear consistent with evidence that impaired self-esteem and dysfunctional self and others schemas constitute risk factors for reality distortion.

Difference in Infarct Volume and Initial Clinical Severity between Stroke Patient with Patent Foramen Ovale and Atrial Fibrillation

Difference in Infarct Volume and Initial Clinical Severity between Stroke Patient with Patent Foramen Ovale and Atrial Fibrillation

The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department

Patients with carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to determine whether lactate levels were associated with the short-term outcome of patients with CO poisoning and identify the characteristics of patients with high initial lactate levels. Eighty patients that presented to the Chonnam National University Hospital after CO poisoning, over 5 years, were enrolled in this retrospective study. Fifty-six (70.0%) patients had high lactate (>2.1 mmo/L) on admission. Thirty-three (41.3%) patients had medical complications and one patient (1.3%) died. The patients with high initial lactate had an altered mental status more frequently, higher WBC, glucose and carboxyhemoglobin (COHb), and lower base deficit on admission. The multivariate analysis showed that lactate was an independent factor associated with serious complications and the need for intensive medical treatment, along with advanced age, WBC, and altered mental status on admission. The results of this study show that the initial lactate was useful for patient prognosis after CO poisoning.

Colonización/infección por Acinetobacter baumannii multirresistente y resistente a carbapenémicos: epidemiología y factores predictivos de infección

Background and objective To study an outbreak of nosocomial colonisation/infection due to multidrug and carbapenem resistant A. baumannii (ABMDR-C). Patients and methods Prospective study of patients with ABMDR-C colonisation/infection (January 2007–June 2008). Epidemiological and clinical variables and predictors of infection versus colonization were analysed. Results 24 out of 101 cases were considered colonisations and 77 infections (27 bacteraemia); global mortality (colonisations and infections) was 42% (4 colonisations and 38 infections -18 bacteraemia). All together, the incidence was 3.2/1000 admissions/day; 29% had been previously admitted and 79% had received previous antibiotic treatment (29% carbapenem; 34% piperacillin-tazobactam; 12.5% boths); 78% had an underlying condition; 81% were UCI patients; 90% had gone through invasive procedures; 65% had another microorganism isolated. In multivariate analysis, infection predictor factors were isolation of ABMDR-C in respiratory samples (OR 5.406; 95% CI 1.419–20.599); male patients (OR 8.842; 95% CI 1.988–39.325); previous hospitalization (OR 9.720; 95% CI 1.383–68.291) and initial clinical severity (OR 30.897; 95% CI 5.533–172.543). Conclusions Our cohort of patients with ABMDR-C colonisation/infection is characterised by their underlying comorbidity, the high rate of previous invasive procedures, previous hospitalisation and previous broad-spectrum betalactam treatments (especially carbapenem). Initial severity and respiratory samples with ABMDR-C isolates were predictors of infection versus colonisation.

Pulsed intravenous cyclophosphamide and methylprednisolone therapy in refractory pemphigus

Pemphigus is a rare autoimmune blistering disorder. The mainstay of current treatment is high-dose oral corticosteroid therapy in combination with a steroid-sparing agent. Adjuvant therapy is important for disease control and to reduce the iatrogenic effects of oral prednisolone. Pulsed therapy with intravenous methylprednisolone and cyclophosphamide (PPC) has been shown to be an effective treatment but there are currently few data on its use in patients who have failed to respond to conventional immunosuppression. To report the clinical and immunological responses of 21 patients with pemphigus refractory to prednisolone and azathioprine or mycophenolate mofetil treated in our department with a standard protocol of monthly PPC. Patients with pemphigus were identified who had undergone PPC therapy during the period between 1997 and 2006. Initial clinical severity and response to treatment was assessed. In addition, change in intercellular antibody titres and desmoglein 1 and 3 antibodies to PPC therapy was also recorded. Of the 21 patients treated, seven had an excellent response, two a good response, five a moderate response, six a minimal response and one patient had no clinical response. Four patients achieved complete clinical remission and the number of pulses for these patients varied between 11 and 22. We observed significant reductions in indirect immunofluorescence titres for normal human skin substrate (P = 0.0078) and antidesmoglein 1 and 3 autoantibody levels (P = 0.007 and P = 0.0085, respectively) from pre-PPC therapy to 1 year after the last pulse. All patients were able to reduce their prednisolone dose from a pre-pulsing median dose of 40-10 mg at the last pulse with a median dose reduction of 66% (P < 0.001). The most common adverse effect was transient lymphopenia (12 patients); nonlife-threatening sepsis (seven patients) and premature ovarian failure (two patients) also occurred. PPC can be an effective treatment for refractory pemphigus but its adverse effects should be considered prior to therapy and closely monitored in patients on treatment.

Changing trends in the clinical course and outcome of bacterial keratitis at King Khaled Eye Specialist Hospital

To evaluate changes in the predisposing factors and causative organisms, clinical course, and outcome of bacterial keratitis at King Khaled Eye Specialist Hospital (KKESH) between 1995 and 2005. Retrospective review of 78 and 103 cases of culture-positive bacterial keratitis admitted to KKESH in 1995 and 2005. Main outcome measures Microbiological cure, visual outcome. There was little change in the predisposing factors for bacterial keratitis, initial clinical severity, or the microbiological profile between 1995 and 2005. While similar topical fortified antibiotic therapy regimens were used in both 1995 and 2005, there was a significant increase in the use of topical corticosteroids in 2005 (P < 0.001), either alone or in combination with medroxyprogesterone 1% and doxycycline. There were significant improvements in the percentage of eyes achieving microbiological cure with medical therapy alone (76.0 vs. 92.2%, P = 0.002) or in combination with surgical intervention (92.4 vs. 100.0%; P = 0.005). The percentage of eyes requiring enucleation or evisceration due to treatment failure declined significantly from 7.6 to 0% (P = 0.006). There was a significant improvement in the percentage of eyes achieving a final visual acuity > or =20/40 (10.1 vs. 29.1%, P = 0.001). Significantly better clinical outcomes were achieved in 2005 compared to 1995. Increased emphasis on management of inflammation in conjunction with the infectious process may have contributed to the improved outcomes.

Correlation of Initial Clinical Presentation and Egg White Specific IgE Values in a Cohort of 104 Egg Allergic Patients

Because the probability of a negative food challenge with egg correlates with the level of egg white specific IgE antibody (egg white-IgE), we investigated the correlation between initial egg white-IgE and initial clinical severity of egg hypersensitivity.

Does sleep protect against ischemic stroke? less frequent ischemic strokes but more severe ones

Stroke occurrence follows a circadian curve, with a higher frequency in the morning. This curve changes if the hours of sleep also change. Our aim was to evaluate the characteristics, risk factors, and prognosis associated with sleep stroke. Patients with ischemic stroke (n = 813), consecutively assessed in our hospital for 2 years, were recorded with the time of clinical onset, pathological antecedents, severity (NIHSS), clinical classification, etiologic TOAST classification, and functional outcome at 3 months (modified Rankin scale). When clinical disturbance appeared during night sleep time it was considered as sleep stroke (SS). The rest were considered wakefulness stroke (WS). Differences SS-WS were analyzed with chi(2), t-student, Mann-Whitney U, and logistic regression tests. From 813 patients included, 127 were SS (15.6%). The SS frequency was less than expected for the corresponding interval of hours. After the univariate analysis and posterior logistic regression, obesity was a factor associated with SS. Adjustment for age and gender revealed that atrial fibrillation (AF) was less frequent in the SS group. There were no differences for other risk factors or in the etiologic distribution. SS had a greater initial clinical severity and a worse functional outcome at 3 months. This functional outcome was dependent on the initial clinical severity. Whilst sleep could be associated with a lesser stroke occurrence, it could also be associated with a higher severity. Obesity appears as a factor related to SS whilst AF appears related to WS.

Response to Letter by Roquer

HomeStrokeVol. 38, No. 3Response to Letter by Roquer Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter by Roquer Christian Foerch and Tobias Neumann-Haefelin Christian FoerchChristian Foerch Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany Search for more papers by this author and Tobias Neumann-HaefelinTobias Neumann-Haefelin Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany Search for more papers by this author Originally published18 Jan 2007https://doi.org/10.1161/01.STR.0000257317.47751.1aStroke. 2007;38:864Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 18, 2007: Previous Version 1 Response:We thank Dr Roquer for the comments on our article. The study by Roquer et al was designed to identify independent predictors of 30-day mortality in intracerebral hemorrhage (ICH) out of a large number of variables.1 In contrast to the results of our study,2 they found previous use of antiplatelets to be an independent predictor of 30-day mortality in 194 consecutive ICH patients. In our study, univariate analysis initially suggested the same result, but multivariate logistic regression showed this to be subject to bias in terms of age and prehospital disability.What might explain the discrepant results? In the study by Roquer et al, we suspect relevant differences in important baseline variables between patients with and without previous antiplatelet use. In detail, 26 of 47 antiplatelet users (55%!) had received antiplatelets as “secondary stroke prevention”. The proportion of patients having had a previous stroke in the nonantiplatelet group is not given but was likely substantially lower. In addition, whereas patients with a premorbid modified Rankin Scale score >2 were excluded, no adjustment was made for premorbid modified Rankin Scale scores between 0 to 2. Finally, the analysis focused solely on 30-day mortality and would have been strengthened by additional data on outcome of ICH survivors.Regarding the specific points of criticism on our study, we do not believe that it is necessary to include initial clinical severity as a parameter into the multivariate model. When we designed our analysis, we anticipated that antiplatelet therapy could be associated with severe neurological deficits at hospital admission, as it is the case for oral anticoagluation. Therefore, initial clinical severity constitutes a dependent variable for which adjustment is not appropriate. Furthermore, we strongly feel that it is a positive and not a negative aspect of our study to have used a large stroke registry with data from more than 100 hospitals. This reflects current stroke care in a more general way than possible by studies performed by one or just a few centers. The question, whether medical procedures, length of hospital stay and mortality rates are different between the hospitals, is of comparatively limited relevance, because all hospitals were located in one federal state and were participating in a quality assurance program.In summary, we are well aware of the fact that conflicting data have been published on this issue. However, based on our study, which analyzed by far the largest patient population so far, the effect of previous antiplatelet therapy on outcome after ICH appears to be either small or nonexistent. However, ultimately only large prospective studies sufficiently powered to control for all relevant parameters will be able to unequivocally resolve the issue.DisclosuresNone.1 Roquer J, Rodriguez Campello A, Gomis M, Ois A, Puente V, Munteis E. Previous antiplatelet therapy is an independent predictor of 30-day mortality after spontaneous supratentorial intracerebral hemorrhage. J Neurol. 2005; 252: 412–416.CrossrefMedlineGoogle Scholar2 Foerch C, Sitzer M, Steinmetz H, Neumann-Haefelin T. Pretreatment with antiplatelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage. Stroke. 2006; 37: 2165–2167.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails March 2007Vol 38, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000257317.47751.1a Originally publishedJanuary 18, 2007 PDF download Advertisement

P1196 PANCREATITIS IN CHILDREN: A 10-YEAR ANALYSIS

Introduction: Acute pancreatitis runs an unpredictable courses. The etiologies, clinical presentations and outcomes are different in children and adults. However, there has no reliable prognostic factor been reported in children’s pancreatitis. Methods: The medical records of 75 patients admitted due to pancreatitis from July 1992 to June 2002 were reviewed retrospectively. The diagnosis of pancreatitis was based on clinical symptoms, elevation of at least threefold of normal upper limit of pancreatic enzymes, and image findings. Data analyses were performed employing the Fisher’s exact test for nominal variables, and nonparametric test for continuous variables. Results: This study comprised 75 patients, including 37 males and 38 females, with 96 episodes of pancreatitis. The mean age was 10.1 ± 4.6 years (range 2 to 18 years). There were 20 patients with unknown etiology (26.7%); 15 with biliary disease (20.0%); 13 with abdominal trauma (17.3%). The common clinical symptoms included abdominal pain (93.8%), vomiting (64.2%), and fever (33.3%). 55 patients were managed conservatively, while the other 20 patients (26.7%) received surgical or other interventional treatment. 13 of them (65%) were associated with biliary tract diseases, 4 (20%) with abdominal trauma, and 3 (15%) with peritonitis. In 85 episodes of non-traumatic pancreatitis, 17 episodes (20%) were severe pancreatitis. Among these patients, 12 had organ failure, DIC or metabolic disturbances, and the other 5 had local complications. 4 patients died of the disease. The mortality rate was 5.3%. We compared initial clinical symptoms, laboratory parameters, and CT severity index between severe and mild pancreatitis. In severe patients, plasma AST, BUN, LDH and CRP level increased, while albumin and calcium levels decreased significantly. The Balthazar CT severity index (CTSI) >5 significantly correlated with severe pancreatitis (p=0.03), and CTSI>6 significantly correlated with death (p=0.03). Conclusion: The overall outcomes of children’s pancreatitis are good, but some of them developed severe disease and may require surgical intervention. CTSI is an applicable and comparable predictor for severe outcomes in children’s pancreatitis.