Oxfordshire Community Stroke Project Classification Research Articles

Validation of a simple clinical tool for screening of acute lacunar stroke-A substudy of the WAKE-UP trial.

Lacunar stroke represents around a quarter of all ischemic strokes; however, their identification with computed tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging. We analyzed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by National Institutes of Health Stroke Scale (NIHSS) < 7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score. We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6) years, 325 (65%) males, median (IQR) NIHSS = 6 (4-9); 108 (22%) lacunar infarcts were identified on magnetic resonance (MR), patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score was negative in 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7, p < 0.001), higher systolic (157 vs 151 mmHg, p = 0.001) and diastolic (86 vs 83 mmHg, p = 0.013) blood pressure and smaller infarct volume (2.4 vs 9.5 mL, p < 0.001). Performance of lacunar score was as follows: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; and accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts. Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials. Data supporting the results of this paper are available upon reasonable request to the corresponding author.

Oxfordshire Community Stroke Project (OCSP) Classification and Mortality Rates in De Novo Ischemic Stroke Among Hispanic Individuals: A Multicentric Analytical Study (P7-5.023)

Oxfordshire Community Stroke Project (OCSP) Classification and Mortality Rates in De Novo Ischemic Stroke Among Hispanic Individuals: A Multicentric Analytical Study (P7-5.023)

Risk factors and characteristics analysis of cognitive impairment in patients with cerebral infarction during recovery period

Objective To analyze the risk factors and characteristics of cognitive impairment in patients with cerebral infarction during the recovery period. Methods This retrospective case-control study included 183 patients with cerebral infarction in the recovery period. According to the MMSE score, they were divided into a cognitive impairment group of 79 cases and a cognitive normal group of 104 cases. Collect clinical data from all patients, including age, gender, body mass index, laboratory test results, past medical history, National Institute of Health Stroke Scale (NIHSS) score, modified Barthel index, Oxfordshire Community Stroke Project (OCSP) classification, and number of infarcted lesions. Multiple logistic regression analysis was used to identify risk factors related to cognitive impairment in patients with cerebral infarction. Result There were significant differences (p < 0.05) between the cognitive impairment group and the cognitive normal group in terms of age, body mass index, low-density lipoprotein level, NIHSS score, modified Barthel index, and number of infarcted lesions. Multivariate logistic regression analysis showed that age ≥ 65 years, stroke, carotid artery plaques, NIHSS score ≥ 5, anterior circulation infarction type, and multiple infarcted lesions were important risk factors for cognitive impairment. Conclusion Elderly age, presence of carotid artery plaques, high NIHSS score, multiple infarct lesions, and specific infarct types are important risk factors for cognitive dysfunction in patients during the recovery period of cerebral infarction.

Recovery, Functional Status, and Health-Related Quality of Life Status up to 4 Years after First-Ever Stroke Onset: A Population-Based Study.

Stroke is a leading cause of acquired disability in adults worldwide, and the burden of stroke is projected to increase. Current long-term stroke outcome data including functional status, activity, and participation limitations as well as information on health-related quality of life (HRQoL) are vital for future rehabilitation and resource planning of stroke survivors. First-ever stroke survivors from a population-based cohort with ischemic stroke or intracerebral hemorrhage were followed up 3-4 years after stroke onset via clinic appointments, home visits, or telephone. Ischemic stroke was stratified by clinical syndrome (Oxfordshire Community Stroke Project classification) and pathogenetic mechanism (TOAST classification). We assessed the participants' functional status and independence with the modified Rankin Scale (mRS) and Barthel Index (BI) and their HRQoL across several domains (Short Form Questionnaire-36, EuroQoL-5D, and Stroke Impact Scale (SIS)). We used logistic and linear regression analyses to analyze potential baseline predictors of 3-4-year outcome. Four hundred individuals were included; 151 died before clinical follow-up and 47 (12%) were lost to detailed follow-up. Two hundred and two individuals (median age: 72, IQR: 65-79; 40% female) were followed up after a median of 3.2 years (IQR: 3.1-3.5). Nineteen individuals (9%) had a recurrent stroke during the 3-4-year follow-up period. Among the 202 follow-up attendees, 147 (73%) had favorable functional outcome (mRS ≤2) and 134 (69%) of the 195 respondents reported good-excellent HRQoL according to SF-36. Age (HR: 1.03; 95% CI: 1.00-1.05), initial stroke severity (HR: 1.16; 95% CI: 1.10-1.22; p &lt; 0.001), living with in-home care or in care facility at baseline (HR: 8.77; 95% CI: 2.98-25.64), and recurrent stroke (HR: 3.58; 95% CI: 1.47-8.77) were predictors of poor functional outcome (mRS&gt;2). Poor functional outcome/death was less common among IS due to Other Causes and Small Artery Occlusion than other pathogenetic mechanisms (20% and 33% vs. 56-68%; p &lt; 0.01). SIS respondents with poor functional outcomes (n = 32) reported worst outcome in the hand domain of SIS (median: 28/100; IQR: 0-73). Most 3-4-year stroke survivors have favorable functional outcomes and are independent in ADL in a population-based cohort. Despite its relative rarity, recurrent stroke was a predictor of poor functional outcome, emphasizing the need of adequate secondary prevention.

Predictors of congruency between clinical and radiographic Oxfordshire Community Stroke Project Classification subtypes

BackgroundThe Oxfordshire Community Stroke Project (OCSP) classification has been widely used to assess ischemic stroke patients based on clinical characteristics alone. However, the correlation between the clinical presentation evaluated using OCSP and imaging findings is yet to be determined. Our study aimed to describe the baseline characteristics of the OCSP subtypes of patients admitted with ischemic stroke and evaluate the predictors of the relationship between clinical and neuroimaging findings. MethodsPatients with a confirmed diagnosis of ischemic stroke admitted to a comprehensive stroke center in Brazil between February 2015 and October 2017 were eligible for the study. All participants underwent computed tomography (CT) at admission and follow-up neuroimaging within seven days, per the institutional protocol. Trained staff classified patients according to the OCSP at hospital admission. The radiographic OCSP classification was retrospectively assessed based on the last follow-up neuroimaging by investigators unaware of the clinical classification. ResultsThe overall agreement rates ranged from 65.5% to 88.7%. Lower NIHSS scores, absent hyperdense MCA sign, higher ASPECTS, and absent brainstem symptoms were related to a higher risk of misclassification. Treatment with intravenous tPA was associated with reclassification in patients with total anterior circulation syndrome. For predicting radiographic posterior circulation involvement, vertigo (OR 2.9, 95% CI 1.7–5.1, p < 0.001) and brainstem symptoms (OR 35, 95% CI 20.5–60.2, p < 0.001) were directly associated with correct classification, but motor and higher cerebral function were not correlated. ConclusionThe clinical OCSP classification presented good congruency rates with the neuroimaging findings. However, patients with lacunar syndromes are often misclassified when radiological criteria are considered.

Prognostic role of optic nerve sheath diameter in stroke in emergency department, A case control study.

Sonographic measurement of optic nerve sheath diameter (ONSD) can reflect intracranial pressure (ICP) indirectly and determine the neurology intensive care unit (NICU) requirement and mortality in acute ischemic stroke (AIS). To demonstrate the effectiveness of ONSD to determine mortality, morbidity, and NICU requirement on patients with the AIS. The sonographic ONSD measurements were performed on each patient with AIS, over 18 years old. All patients were categorized according to the Oxfordshire Community Stroke Project (OCSP) classification system. MRI images were examined for increased ICP, and the patients were categorized into two groups as increased ICP (i-ICP) and normal ICP. The ONSD results were evaluated in terms of classifications, outcomes, and prognosis of the patients. One hundred and five patients were included and 31 (35.2%) were in the i-ICP group. The median ONSDs were 5.26 mm in the i-ICP group and 4.62 mm in the normal ICP group (P < 0.001). The median ONSDs were 5.13 mm in the NICU group and 4.69 mm in the neurology ward (NW) group (P = 0.001). The total anterior circulation infarction (TACI) subgroup had higher ONSDs than the others (TACI: 5.27 mm; PACI: 4.73 mm; POCI: 4.77 mm; and LACI: 4.64 mm, P < 0.001). The NICU requirements were higher in the TACI subgroup. The median ONSD was 5.42 mm in the deceased group (survived: 4.77 mm, P < 0.001). ONSD may be favorable for predicting the increased ICP and the NICU requirement in OCSP subgroups. Moreover, ONSD can be used to foresee the mortality of AIS.

Prediction of acute cerebrovascular stroke disability using mSOAR score (Stroke subtype, Oxfordshire Community Stroke Project, age, mRS and NIHSS)

BackgroundStroke is among the most prevalent causes of disability. An easy reliable tool to predict stroke outcomes will help manage neurological and non-neurological events and rehabilitation. The modified SOAR (mSOAR) score, which includes stroke subtype, Oxfordshire Community Stroke Project (OCSP) classification, age, pre-stroke modified Rankin score (mRS), and National Institutes of Health Stroke Scale (NIHSS) is simple and easily calculated prognostic tool. The objective of this research was to test the ability of the mSOAR score to predict post-stroke disability as measured by mRS at discharge and 1 month after stroke onset.ResultsOne hundred stroke patients (aged ≥ 18 years) were included. All subjects underwent complete neurologic examination, non-contrast head computed tomography. OCSP classification, Stroke subtype, NIHSS, and mRS score on discharge and 1 month after stroke onset were assessed for all patients. The mSOAR score was significantly correlated with mRS on discharge, after 1 month of stroke, and with the length of hospital stay. mSOAR score had high sensitivity and specificity for predicting moderate-to-severe disability on discharge and after 1 month of stroke onset.ConclusionThe mSOAR is an excellent and accurate tool for predicting the severity of disability on discharge and 1-month post-stroke.

Clinical and Imaging Phenotypes and Outcomes in a Costa Rican Cohort of Acute Ischemic Stroke Survivors: A Retrospective Study.

We characterized clinical and imaging phenotypes and their association with clinical outcomes in acute ischemic stroke (AIS) survivors in the understudied region of Costa Rica. We conducted a retrospective cohort study in AIS patients treated at a tertiary stroke center in Costa Rica from 2011-2015. Participants underwent detailed phenotyping for cardiovascular risk factors and stroke etiology. We assessed the association of ischemic brain lesion features and clinical outcomes using the Oxfordshire Community Stroke Project (OCSP) classification. We included 684 AIS survivors (60.2% males, aged 68.1 ± 13.6 years, mean ± SD). While the cardiovascular risk profiles and mortality rates of our patients were similar to populations in European and North American countries, only 20.2% of patients with atrial fibrillation (AF) received anticoagulation. On multivariable analysis, patients with total anterior circulation infarct (TACI) displayed an increased risk of complications (OR: 4.2; 95% CI: 2.2-7.8; p < 0.001), higher mortality (OR: 6.9; 95% CI: 2.9-16.1; p < 0.001) and lower chance of functional independence at discharge (OR: 8.9; 95% CI: 4.1-19; p < 0.001) compared to non-TACI. The comorbidity of bronchopneumonia increased the probability of death by 14.5 times. Our observations in a Costa Rican cohort of AIS survivors might help improve local measures for preventing and managing AIS.

Correlations Between Serum CXCL9/12 and the Severity of Acute Ischemic Stroke, a Retrospective Observational Study.

This retrospective observational study was conducted to determine the correlations between serum CXCL9/12 and the severity of acute ischemic stroke (AIS). Total 138 patients with AIS were enrolled in the study. These patients underwent Brain CT on admission and blood samples were collected. Serum CXCL9 and CXCL12 were detected by ELISA assay. The correlations of serum CXCL9/12 with AIS was analyzed based on Oxfordshire Community Stroke Project (OCSP) classification, Trial of Org 10,172 in acute stroke treatment (TOAST) classification, National Institutes of Health Stroke Score (NIHSS) score, infarct volume, and modified Rankin scale (mRS) score. Compared with the controls, patients with AIS had higher levels of serum CXCL9 and CXCL12. Logistic regression analysis determined that CXCL9 and CXCL12 were independent risk factors for AIS. In addition, the increased serum CXCL9 and CXCL12 were associated with TOAST classification, NIHSS score, and infarct volume. However, serum CXCL9 and CXCL12 were not associated with functional outcomes (mRS score). CXCL9 and CXCL12 both exhibited a high diagnostic value in AIS. Serum CXCL9 and CXCL12 were elevated in patients with AIS, closely correlated with the severity of AIS.

The moderating effect of cognitive reserve on cognitive function in patients with Acute Ischemic Stroke.

Recovery of cognitive function after stroke has inter-individual variability. The theory of cognitive reserve offers a potential explanation of the variability in cognitive function after stroke. This study aimed to investigate the moderating effect of cognitive reserve on the relationship between the stroke severity and cognitive function after stroke. A total of 220 patients with Acute Ischemic Stroke (AIS) were recruited in 2021 from two stroke centers in Nanjing, China. The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity upon admission. Cognitive Reserve Index questionnaire (CRIq) and validated Montreal Cognitive Assessment, Changsha Version (MoCA-CS) were used to assess cognitive reserve and cognitive function within 7 days after stroke onset, respectively. A series of multivariate linear regression models were applied to test the moderating effect of cognitive reserve. Patients with a higher level of cognitive reserve had better cognitive function after stroke compared with those with a lower level of cognitive reserve (β = 0.074, p = 0.003). The interaction of NIHSS and cognitive reserve was statistically significant (β = -0.010, p = 0.045) after adjusting for some key covariates [e.g., age, marital status, Oxfordshire Community Stroke Project (OCSP) classification, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, cerebral vascular stenosis, diabetes and atrial fibrillation]. Cognitive reserve may help to buffer the effect of stroke-related pathology on cognitive decline in Chinese acute stroke patients. Enhancing cognitive reserve in stroke patients may be one of the potential strategies for preventing vascular dementia.

Correlation between Indonesian Version of Montreal Cognitive Assessment Score and Hospital Anxiety and Depression Scale Scores for Post-Stroke Patients

Background: Cerebrovascular disease, with its complex anatomy, and various parts of the brain can cause neurological deficits. The Oxfordshire Community Stroke Project classification distinguishes a posterior circulation infarct (PCI) from an Anterior Circulation Infarction (ACI) by using radiological examination. Anxiety after stroke occurs in about 24% of patients and it is a problem with quality of life associated with poor health. In Post Stroke Anxiety (PSA), there are still few studies on prevention, risk factors and therapeutic interventions. More than 40% of stroke sufferers have cognitive impairment or post stroke cognitive impairment (PSCI). &#x0D; Objectives: To determine the correlation between Indonesian Version of Montreal Cognitive Assessment Score (MoCA-INA) and the Hospital Anxiety and Depression Scale Scores (HADS-A) for post-stroke patients in neurological road care installation in University of Sumatera Utara Hospital. &#x0D; Methods: This is a numerical correlation study with a cross-sectional approach.. The sampling method is non-probability sampling with consecutive sampling type. The research subjects were then examined for the total MOCAINA score. Then, the research subjects are examined for HADS-A. After all the results of the examination, the questionnaire and the subject's personal data are completely filled in, the questionnaire is collected. The analysis uses the Spearman correlation test &#x0D; Results: The results of the analysis using the Spearman correlation test for the correlation between MoCA-INA total score and HADS-A total score, the value of r is -0.602 with p value &lt;0.001 (the correlation is very significant with negative correlation direction and the strength of the correlation is strong). &#x0D; Conclusions and Suggestions: With the influence of MoCa-INA score on the HADS-A score in post-stroke patients, it can provide an input for health workers to immediately detect and anticipate events of cognitive decline and anxiety in post-stroke patients.

Prognostic Factors in Patients with Acute Cerebral Infarction Undergoing Intravenous Thrombolytic Bridging Artery Thrombectomy

To study the prognostic factors and preventive nursing of patients with acute cerebral infarction treated with intravenous thrombolytic bridging artery thrombectomy is the objective of the study. From January 2017 to December 2019, 80 patients with acute cerebral infarction in the Department of Neurology of our hospital were selected, all of whom were treated with intravenous thrombolytic bridging arterial thrombectomy, using stroke unit, establishing a green channel, combining with the evaluation of the prognosis of patients, analyzing the related risk factors affecting the prognosis and guiding the clinical prevention and nursing countermeasures, improve the prognosis of the operation. The National institutes of health stroke scale score decreased gradually from before treatment to 1 h, 2 h, 3 h, 4 h, 5 h, 6 h, 24 h, 7 d and 14 d after treatment. In terms of prognosis, the total effective rate was 93.75 %. The total incidence of adverse reactions and complications were 5.00 %. Multivariate analysis showed that age, National institutes of health stroke scale classification before thrombolysis, blood glucose before thrombolysis, Oxfordshire community stroke project classification and 24 h improvement after thrombolysis were independent predictors of prognosis (p<0.05). In patients with acute cerebral infarction undergoing intravenous thrombolytic bridging artery thrombectomy, stroke unit and emergency department should be seamlessly docked and postoperative neurological intensive care should be strengthened. It can collect the relevant risk factors affecting the prognosis of surgery, analyze the relationship between risk factors and the prognosis of surgery, and propose preventive nursing measures to reduce postoperative complications and improve the prognosis.

Prognostic analysis of different therapeutic regimens in patients with acute cardiogenic cerebral embolism

BackgroundFew studies focused on the functional outcomes of patients at 3 months after receiving intravenous thrombolysis, anticoagulation, or antiplatelet therapy within 4.5 h of onset of the cardiogenic cerebral embolism (CCE) subtype.MethodsThe purpose of this retrospective study was to analyse the clinical data of patients with acute CCE and compare the 3-month functional prognoses of patients after administration of different antithrombotic therapies within 4.5 h of stroke onset. A total of 335 patients with CCE hospitalized in our institution were included in this study. The patients were stratified according to the hyperacute treatment received, and baseline clinical and laboratory data were analysed. A 3-month modified Rankin scale (mRS) score of 0–2 was defined as an excellent functional outcome.ResultsA total of 335 patients were divided into thrombolytic (n = 78), anticoagulant (n = 88), and antiplatelet therapy groups (n = 169). A total of 164 patients had a good prognosis at 3 months (mRS ≤ 2). After adjustments were made for age and National Institute of Health Stroke Scale (NIHSS) score, each group comprised 38 patients, and there were no significant differences in sex composition, complications, lesion characteristics, or Oxfordshire Community Stroke Project (OSCP) classification among the three groups. The plasma D-dimer level (µg/ml) in the thrombolytic group was significantly higher than those in the anticoagulant and antiplatelet groups [3.07 (1.50,5.62), 1.33 (0.95,1.89), 1.61 (0.76,2.96), P < 0.001]. After one week of treatment, the reduction in NIHSS in the thrombolytic group was significantly greater than those in the other two groups [3.00 (1.00, 8.00), 1.00 (0.00, 5.00), 1.00 (0.00, 2.00), P = 0.025]. A total of 47 patients (41.2 %) had an mRS score of ≤ 2 at 3 months, and 23 patients died (20.2 %). There was no significant difference in the proportion of patients with a good prognosis or the mortality rate among the three groups (P = 0.363, P = 0.683).ConclusionsThrombolytic therapy is effective at improving short-term and 3-month prognoses. Anticoagulant therapy may be a safe and effective treatment option for patients with the cardiac stroke subtype who fail to receive intravenous recombinant tissue plasminogen activator (r-tPA) thrombolysis within 4.5 h in addition to antiplatelet therapy, as recommended by the guidelines.

Predicting 10-year stroke mortality: development and validation of a nomogram

Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96–9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62–3.14), eGFR < 15 (1.97, 1.55–2.52), 1-year increment in age (1.04, 1.04–1.05), liver disease (1.50, 1.20–1.87), peripheral vascular disease (1.39, 1.23–1.57), cancers (1.37, 1.27–1.47), heart failure (1.24, 1.15–1.34), 1-point increment in pre-stroke mRS (1.20, 1.17–1.22), atrial fibrillation (1.17, 1.10–1.24), coronary heart disease (1.09, 1.02–1.16), chronic obstructive pulmonary disease (1.13, 1.03–1.25) and hypertension (0.77, 0.72–0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.

P-OT024. Stroke subtypes and in-hospital mortality in patients with systemic lupus erythematosus in dr. sardjito hospital yogyakarta

Introduction . Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that associated with an increased risk of stroke especially in young patient. Individuals with SLE have a two-fold higher risk of stroke infarct and three-fold higher for intracerebral hemorrhage. Survival after stroke in SLE patient is lower compared to the general population. This study was conducted to determine the subtypes of stroke and in-hospital mortality in patients with SLE. Methods . A descriptive cross-sectional study. Subjects were SLE patients that had stroke and hospitalised at Dr. Sardjito Hospital from January 1st, 2015 until December 31st, 2019. Patients were diagnosed with SLE based on American College of Rheumatology Classification Criteria and stroke diagnosis was made by neurological examination and imaging finding (head CT scan/MRI). Results . All of the subjects were female with total 23 patients. The mean age was 33,65 (12,86) years old. There were 16 (69,6%) subjects having stroke infarct, 6 (26,1%) subjects having intracerebral hemorrhage and only one (4,3%) having subarachnoid hemorrhage. The most common subtypes of stroke infarct based on Oxfordshire Community Stroke Project (OCSP) classification was partial anterior circulation infarction (PACI) that was found in 11 (68,8%) subjects. In-hospital mortality was found in 10 (43,5%) subjects which 7 (30,4%) of them have had stroke infarct and 6 (26,0%) of them were categorized into age group below 40 years old. Conclusion . Subject in this study was female predominance. It was because SLE typically affects females rather than males. The most common subtypes of stroke was partial anterior circulation infarction. SLE could trigger the formation of blood clots that leads to inflammatory changes in blood vessels, which create a prothrombotic state, and increase risk of thromboembolism. In-hospital mortality was mostly found in stroke infarct and young subjects.

Oxfordshire Community Stroke Project Classification: A proposed automated algorithm.

The Oxfordshire Community Stroke Project (OCSP) proposed a clinical classification for Stroke patients. This classification has proved helpful to predict the risk of neurological complications. However, the OCSP was initially based on findings on the neurological assesment, which can pose difficulties for classifying patients. We aimed to describe the development and the validation step of a computer-based algorithm based on the OCSP classification. A flow-chart was created which was reviewed by five board-certified vascular neurologists from which a computer-based algorithm (COMPACT) was developed. Neurology residents from 12 centers were invited to participate in a randomized trial to assess the effect of using COMPACT. They answered a 20-item questionnaire for classifying the vignettes according to the OCSP classification. Each correct answer has been attributed to 1-point for calculating the final score. Six-two participants agreed to participate and answered the questionnaire. Thirty-two were randomly allocated to use our algorithm, and thirty were allocated to adopt a list of symptoms alone. The group who adopted our algorithm had a median score of correct answers of 16.5[14.5, 17]/20 versus 15[13, 16]/20 points, p = 0.014. The use of our algorithm was associated with the overall rate of correct scores (p = 0.03). Our algorithm seemed a useful tool for any postgraduate year Neurology resident. A computer-based algorithm may save time and improve the accuracy to classify these patients. An easy-to-use computer-based algorithm improved the accuracy of the OCSP classification, with the possible benefit of further improvement of the prediction of neurological complications and prognostication.

Do We Need to Distinguish Thrombolysis and Nonthrombolysis Patients When Applying Stroke-Associated Pneumonia Predicting Scores? An External Validation from a 2-Center Database.

BackgroundDue to the lack of validation for predictive scoring of stroke-associated pneumonia in both thrombolysis- and nonthrombolysis-treated ischemic stroke (IS) patients, this study aimed to evaluate 4 scoring methods in the 2 subgroups.Material/MethodsThe CerebroVascular Database Project database included data from patients with cerebral IS that were admitted in 2 hospitals from February 2016 to January 2018. A total of 138 thrombolysis-treated and 138 nonthrombolysis-treated IS patients were enrolled. Area under receiver operating characteristic curves (AUROC) were performed to examine the discrimination of the 4 scores, and Hosmer-Lemeshow test was used to evaluate the goodness of fit.ResultsThe incidence of stroke-associated pneumonia was 24.8%. The thrombolysis and nonthrombolysis subgroups were not significantly different with regard to sex, present smoking, chronic obstructive pulmonary disease history, atrial fibrillation history, blood pressure, or glucose level on admission. However, significant differences were found in National Institutes of Health Stroke Scale scores (P<0.001), Glascow Coma Scale scores (P<0.001), Oxfordshire Community Stroke Project classification (P<0.001), dysphagia (P<0.001), and white blood cell counts (P=0.039). The AUROC for the Age, Atrial fibrillation, Dysphagia, male Sex, stroke Severity, National Institutes of Health Stroke Scale; Preventive ANtibacterial THERapy in acute Ischemic Stroke; Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS); and Independence, Sex, Age, National Institutes of Health Stroke Scale scores in total population were 0.80 (0.74–0.84), 0.75 (0.69–0.80), 0.80 (0.76–0.85), and 0.76 (0.71–0.81). The goodness of fit was 0.22, 0.22, 0.27, and 0.17, respectively. The AUROC of 4 scores between subgroups were not statistically significant.ConclusionsThe AIS-APS had the highest AUC and goodness of fit in our population. All 4 scores can be applied regardless of whether thrombolysis has been performed on patients.

Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study.

The role of patent foramen ovale (PFO) in cryptogenic stroke (CS) is debated. Tools to predict PFO occurrence and attributable fraction are needed to guide cost-effective diagnostics and treatment. Risk of Paradoxical Embolism (RoPE) score relies on neuroimaging findings, which might be inconclusive in up to 30% of cases. We developed a clinical-based easy tool to predict the presence and attributable fraction of PFO in CS patients, without using neuroimaging. The clinical RoPE (cRoPE) score, ranging 1-10, was elaborated through Delphi method from the original RoPE score, replacing cortical infarction with the Oxfordshire Community Stroke Project (OCSP) classification (lacunar stroke = 0 points, other subtypes = 1 point). Then, from the SISIFO (Studio Italiano di prevalenza nello Stroke Ischemico di pervietà del Forame Ovale, or Prevalence of Patent Foramen Ovale in Ischemic Stroke in Italy) study, a multicenter, prospective study on consecutive acute ischemic stroke patients (n= 1130) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST) and OCSP criteria and undergoing PFO testing, we selected the VV-CDC cohort (Vibo Valentia, Città di Castello, n= 323) to test the accuracy of cRoPE in predicting PFO detection. We compared cRoPE with RoPE to verify cRoPE reliability. Finally, we tested, through ROC analysis, the performance of cRoPE depending on TOAST classification. Overall, PFO was detected in 21% in VV-CDC and in 23.4% in remaining SISIFO cohort (n= 807). cRoPEAUC and RoPEAUC were similar in VV-CDC. cRoPE performance was comparable with RoPE among CS (cRoPEAUC 0.76, 95%CI 0.67-0.85, RoPEAUC 0.75, 95%CI 0.66-0.84). Moving to the remaining SISIFO cohort, cRoPE confirmed satisfactory accuracy in predicting PFO detection in CS patients (cRoPEAUC 0.71, 95%CI 0.66-0.78, p= 0.032). Conclusions:cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.

Strok alt gruplarında lenfosit monosit oranındaki değişimin değerlendirilmesi

Abstract Backround: Stroke is one of the most important disease causing serious morbidity and mortality worldwide. There are some studies showing the change in hematological inflammatory markers in stroke patients. Lymphocyte to monocyte ratio (LMR) is considered to be a new hematological inflammatory marker that has been recently investigated in many malignancies with its particularly low level. In this study, we aimed to evaluate the levels of LMR in patients presented to our emergency department with neurological findings, diagnosed as ischemic stroke and also we aimed to evaluate the levels of LMR in subgroups according to the Oxfordshire Community Stroke Project (OCSP) classification which is a clinical classification. Material and Methods: The patients admitted to the emergency department of a university hospital with symptoms of neurological disorders and diagnosed with ischemic stroke between January 2017 and January 2019 were retrospectively analyzed. Stroke patients were divided into subgroups according to OCSP classification and clinical and imaging results were correlated. Hematologic inflammatory markers were examined in all groups and changes in LMR were detected. Results: 109 (63 female, 46 male) ischemic stroke patients and 110 (45 female, 65 male) control patients were included in the study. The low LMR values were found to be statistically significant in stroke cases compared to the control group (p &amp;lt;0.05). The low LMR values were found to be statistically significant in all four subgroups compared to the control group (p &amp;lt;0.05). TACI and POCI groups showed the lowest mean in LMR values. Higher NLR and GGT values were found to be statistically significant in all four groups compared to the control group (p &amp;lt;0.05). Conclusion: In our study, the LMR value, which was limited investigated in stroke subgroups, was found to be low in all stroke and subgroups. Especially in clinical situations with large infarct sizes such as TACI and POCI groups, the lowest means were reached. It is thought that LMR can be used as a predictor of mortality, morbidity, and prognosis in both stroke and its subgroups.

EMR-Based Phenotyping of Ischemic Stroke Using Supervised Machine Learning and Text Mining Techniques.

Ischemic stroke is a major cause of death and disability in adulthood worldwide. Because it has highly heterogeneous phenotypes, phenotyping of ischemic stroke is an essential task for medical research and clinical prognostication. However, this task is not a trivial one when the study population is large. Phenotyping of ischemic stroke depends primarily on manual annotation of medical records in previous studies. This article evaluated various strategies for automated phenotyping of ischemic stroke into the four subtypes of the Oxfordshire Community Stroke Project classification based on structured and unstructured data from electronical medical records (EMRs). A total of 4640 adult patients who were hospitalized for acute ischemic stroke in a teaching hospital were included. In addition to the structured items in the National Institutes of Health Stroke Scale, unstructured clinical narratives were preprocessed using MetaMap to identify medical concepts, which were then encoded into feature vectors. Various supervised machine learning algorithms were used to build classifiers. The study results indicate that textual information from EMRs could facilitate phenotyping of ischemic stroke when this information was combined with structured information. Furthermore, decomposition of this multi-class problem into binary classification tasks followed by aggregation of classification results could improve the performance.