Post-acute Stroke Research Articles

Abstract WP197: Patient-Reported Physical Outcomes Measures in Mild-to-Moderate Stroke and TIA Patients

Introduction: Mild-to-moderate stroke and TIA patients are discharged directly home, but may have residual physical disability. The purpose of this study was to compare distributions of three patient-reported outcome measures: PROMIS GPH, Stroke Impact Scale-16 (SIS-16), and simplified modified Rankin (Rankin). Methods: PROMIS GPH includes global ratings of physical activities, physical health, pain and fatigue, SIS-16 includes ADLs, IADLs, and physical activities, and Rankin includes ADLs, IADLs, and overall comparison of function to pre-stroke function. Outcomes were measured at 90-days post-hospital discharge in 1768 stroke and TIA patients discharged directly home in the COMprehensive Post-Acute Stroke Services Study. Ceiling effects (frequency of maximum score) were evaluated for each measure. Differences in SIS-16 and PROMIS GPH scores across levels of Rankin were compared using the Kruskal-Wallis test. Spearman correlation coefficients were calculated between PROMIS GPH, SIS-16, Rankin, and individual items of the PROMIS GPH. Results: At hospital baseline, patients were 68 ± 13 years of age, 50% female, 72% stroke, 28% TIA, and with mean ± SD NIHSS of 2.3 ± 3.6. At 90 days, mean ± SD were 45.8 ± 9.8 for PROMIS GPH, 82.1 ± 19.7 for SIS-16, and 1.2 ± 1.3 for Rankin. Ceiling effects for the PROMIS GPH were (3.1%), SIS-16 (24.8%) and Rankin (38.9%). PROMIS GPH and SIS-16 scores differed significantly (p < 0.0001) across categories of the Rankin. Correlations with Rankin were moderate for SIS-16 (r=-0.64; 95% CI -0.67, -0.62) and PROMIS GPH (r=-0.54; 95% CI -0.58, -0.51). Correlations between SIS-16 and PROMIS GPH items were strong for physical activities (r=0.75; 95% CI 0.63, 0.77) and moderate for physical health (r=0.55; 95% CI 0.52, 0.59), fatigue (r=0.50; 95% CI 0.47, 0.54) and pain (r=0.44; 95% CI 0.40, 0.48). Of 438 patients at SIS-16 ceiling, the mean ± SD for global assessment of physical activities, physical health, pain, and fatigue on a scale of 0-5 were 4.8 ± 0.6, 3.7 ± 0.9, 4.4 ± 0.9, and 4.2 ± 0.7, respectively. Conclusion: PROMIS GPH may better detect physical health differences in mild-to-moderate stroke and TIA patients. Variability in global assessments of physical health, pain, and fatigue contribute to the lower PROMIS GPH ceiling effects.

Acupuncture for stroke: perceptions and possibilities

To investigate perceptions and acceptability of, and attitudes towards, acupuncture for post-acute stroke and rehabilitation care by exploring the views of different stakeholders. Three electronic surveys were conducted to gauge the breadth of knowledge and acceptance of acupuncture in post-acute stroke and rehabilitation care among three stakeholder groups: (1) traditional acupuncturists registered with the British Acupuncture Council (BAcC); (2) National Health Service (NHS) professionals attending the 2017 UK Stroke Forum conference; and (3) the UK network of Stroke Club co-ordinators. Of 278 NHS respondents, 31% were doctors. Over half (52%) of all NHS respondents reported they had insufficient knowledge about acupuncture, its effectiveness (23%) or how to refer (21%). Only 12% had previously referred stroke patients for acupuncture but 46% thought that there was role for acupuncture in post-acute stroke care (50% were unsure). Two thirds of BAcC acupuncturist respondents had treated at least one stroke patient, with 70.1% having treated 1-5 stroke patients and 71% having provided treatment in the last year, most commonly for motor impairment (88.2%). Of 99 Stroke Club coordinators who responded, only seven had ever been asked about acupuncture by patients, but most felt there would be interest. Interest in the provision of acupuncture for post-acute stroke care was expressed by both NHS practitioners and acupuncturists. Further research is required on the acceptability of acupuncture to patients as well as evidence of its clinical and cost effectiveness.

Factors affecting the duration to achieve independence of upper-body dressing in post-acute stroke patients

Factors affecting the duration to achieve independence of upper-body dressing in post-acute stroke patients

Patient Factors Associated With Attendance at a Comprehensive Postacute Stroke Visit: Insight From the Vanguard Site

ObjectiveTo understand the patient-influenced activities and characteristics associated with return to a single postacute care transitional care clinic visit in a cohort of patients cared for at the test health system site of the larger Comprehensive Post-Acute Stroke Services (COMPASS) cluster randomized trial. DesignRetrospective cohort. SettingA large health system. ParticipantsPatients discharged directly home between June 2016 and June 2018 after sustaining a stroke who did not receive formal inpatient rehabilitation services while being cared for in a single comprehensive stroke center, defined as a center that meet standards to rapidly diagnose and treat the most complex stroke cases. InterventionsStudy participants had the opportunity to participate in a (1) 2-day call, (2) comprehensive care transitions clinic visit, and (3) individualized care plan. Main Outcome MeasuresPatient participation in a single postacute care comprehensive care transitions visit, ideally completed within 7-14 calendar days post discharge vs not attending this visit. Care transition visits are where the responsibility for preventive care, other services, and posthospital follow-up are transitioned to outpatient providers. ResultsAmong 1300 eligible patients (mean age 64.8 years; 45% female; 25.4% nonwhite; 9.7% uninsured), 95.7% had follow-up clinic visits scheduled before discharge, 22.6% received home health referrals before discharge, 60.2% completed the 2-day call, and 63.2% attended the COMPASS visit. Among attendees, 33.2% attended by day 14, 71.3% attended within 30 days, and 28.7% attended after day 30. The median driving distance to the COMPASS visit was 45.9 miles or 73.9 km. Odds of visit attendance were higher if COMPASS 2-day follow up calls were completed, if follow-up clinic appointments were scheduled before discharge, if the patient had a primary care provider, and if the patients experienced a stroke vs a transient ischemic attack. Additionally, when we used the number of referrals at hospital discharge for different types of outpatient therapy as a surrogate marker of poststroke impairment, patients having no therapy referrals (milder to no impairments) had lower odds of attending the COMPASS visit than those with 1 therapy referral. Likewise, those with more than 1 referral were also less likely to attend the COMPASS visit. ConclusionsThis analysis highlights that scheduling visits at discharge and completing timely telephone follow-up shortly after discharge may lead to greater adherence to in-person clinic follow-up after stroke.

Diagnostic particularities and multimodal therapeutic and rehabilitation approches to a complex case of post ischemic stroke with dyshphagia and dysphonia, associating Millard-Gubler and Wallenberg syndromes- case report

Introduction. Millard-Gubler syndrome (MGS), also known as the ventral pontine syndrome or hemiplegic syndrome, is one of the classical crossed syndromes characterized by a unilateral lesion of the basal portion of the caudal part of the pons. MGS manifests as ipsilateral palsy of CN VI and VII with contralateral hemiplegia. Wallenberg syndrome or lateral medullary syndrome, is characterized by the triad of Horner's syndrome, ipsilateral ataxia and contralateral hypoalgesia. Other clinical symptoms may include difficult swallowing, slurred speech, vertigo, nausea, vomiting, dyspnea, tachycardia, headaches and muscular hypertonia. Materials and Methods Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee N.O 20270 from the 26th of June 2019, the current case report presents a 67-year-old male patient from rural area with left hemiplegia (complete brachial and crural motor deficit), right eye abduction paresis, dysphagia, dysphonia, central facial palsy - all post acute ischemic stroke. The patient was also diagnosed with ischemic cardiomyopathy, atherosclerosis, alcoholism, type 2 diabetes with Insulin therapy and oral antidiabetic agent. The patient was admitted in the Neurorehabilitation Clinic of the Teaching Emergency Hospital „Bagdasar-Arseni” (TEHBA) Bucharest, Romania, associating severe alteration in self-care abilities, locomotor dysfunction, memory disorders, slurred speech, for specialized rehabilitation treatment and nursing. Results. A case of rare pathology for which, unfortunately, there is a discrepancy between functional improvement and the poor motor control in the in the lower limbs (muscle force was 0-1 out of 5 on the Medicale Research Council scale), within an overall favorable evolution, including elements of the clinical status afferent to the two above mentioned syndromes. Conclusions. Approaching such a clinical case has been a complex and extensive challenge for the entire neuromuscular recovery team and remains similar for any other squad. This pathology remains an issue that demands our earnest attention. Key words: Millard-Gubler syndrome (MGS), Wallenberg syndrome, crossed syndromes, hemiplegia, neurorehabilitation, stroke

An Overview of Systematic Reviews and Meta- analyses on Acupuncture for Post-acute Stroke Dysphagia.

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. Methods: Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2–96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.

Implementation of a billable transitional care model for stroke patients: the COMPASS study

BackgroundThe COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic trial compared the effectiveness of comprehensive transitional care (COMPASS-TC) versus usual care among stroke and transient ischemic attack (TIA) patients discharged home from North Carolina hospitals. We evaluated implementation of COMPASS-TC in 20 hospitals randomized to the intervention using the RE-AIM framework.MethodsWe evaluated hospital-level Adoption of COMPASS-TC; patient Reach (meeting transitional care management requirements of timely telephone and face-to-face follow-up); Implementation using hospital quality measures (concurrent enrollment, two-day telephone follow-up, 14-day clinic visit scheduling); and hospital-level sustainability (Maintenance). Effectiveness compared 90-day physical function (Stroke Impact Scale-16), between patients receiving COMPASS-TC versus not. Associations between hospital and patient characteristics with Implementation and Reach measures were estimated with mixed logistic regression models.ResultsAdoption: Of 95 eligible hospitals, 41 (43%) participated in the trial. Of the 20 hospitals randomized to the intervention, 19 (95%) initiated COMPASS-TC.Reach: A total of 24% (656/2751) of patients enrolled received a billable TC intervention, ranging from 6 to 66% across hospitals.Implementation: Of eligible patients enrolled, 75.9% received two-day calls (or two attempts) and 77.5% were scheduled/offered clinic visits. Most completed visits (78% of 975) occurred within 14 days.Effectiveness: Physical function was better among patients who attended a 14-day visit versus those who did not (adjusted mean difference: 3.84, 95% CI 1.42–6.27, p = 0.002).Maintenance: Of the 19 adopting hospitals, 14 (74%) sustained COMPASS-TC.ConclusionsCOMPASS-TC implementation varied widely. The greatest challenge was reaching patients because of system difficulties maintaining consistent delivery of follow-up visits and patient preferences to pursue alternate post-acute care. Receiving COMPASS-TC was associated with better functional status.Trial registrationClinicalTrials.gov number: NCT02588664. Registered 28 October 2015.

Opportunities and Limitations of Vascular Risk Factor Models in Studying Plasticity-Promoting and Restorative Ischemic Stroke Therapies.

Major efforts are currently made promoting neuronal plasticity and brain remodeling in the postacute stroke phase. Experimental studies evaluating new stroke therapies are mostly performed in rodents, which compared to humans exhibit a short lifespan. These studies widely employ young, otherwise healthy, rodents that lack the vascular risk factors and comorbidities of stroke patients. These risk factors compromise postischemic neurological recovery and brain plasticity and in several contexts reduce the brain responsiveness to recovery-inducing plasticity-promoting treatments. By examining risk factor models, which have hitherto been used for studying experimentally induced ischemic stroke, this review outlines the possibilities and limitations of risk factor models in the evaluation of plasticity-promoting and restorative stroke treatments.

Neurorestoration: Programme management for post-ischemic stroke patients

ABSTRACT There are a few systematical studies on the programme management for post-ischemic stroke using a specific template as the template for intervention description and replication (TIDieR) to improve outcomes of an intervention. The present study aimed to measure the impact of neurorestoration as a programme management using motor learning apply with a validated TIDieR that was specifically designed for post-ischemic stroke patients. A pre-post-test randomized control trial was conducted on 64 post-acute ischemic stroke patients who had the inclusion criteria in a week. Control groups (n = 32) received the routine mobilization with a conventional method based on hospital procedures, while treatment groups (n = 32) underwent structured motor learning with a modified TIDieR. Motor learning improvement was considered as a functional ability that was measured by applying the Barthel Index. Statistical analysis was performed using the Independent Samples t-test. The improved functional abilities (mean ± SD) were 27.41 ± 20.10 and 41.66 ± 21.66 in control and treatment groups respectively (P = 0.008). The improvement of functional ability in treatment groups was approximately 1.5 times higher than the control groups. Programme management using motor learning through the TIDieR improved functional abilities of post-ischemic stroke patients compared to the conventional method.

Effects of a robot intervention on visuospatial hemineglect in postacute stroke patients: a randomized controlled trial

Objective: To evaluate the effects of an intervention using the robot device PARO on visuospatial hemineglect and activities of daily living, and its acceptance during stroke rehabilitation. PARO is an interactive robotic toy with the appearance of a baby seal, which can move, produce sounds, and react to speech and touch. Design: A randomized controlled trial. Setting: Hospital for neurorehabilitation. Subjects: Patients above 60 years old who have suffered their first stroke within the previous three months with left hemineglect (n = 39). Interventions: The PARO group (n = 21) was exposed to PARO over a period of two weeks, three times per week. The participants of the control group (n = 18) were read to aloud. Outcome measure: Visuospatial hemineglect was measured by a cancellation test and a Line Bisection Test, and independence in the activities of daily living was assessed by Scores of Independence Index for Neurological and Geriatric Rehabilitation (SINGER) test. The acceptance of PARO was also evaluated. Data were collected blinded at three times: baseline (T0), after two weeks of interventions (T1), and after additional two weeks as follow-up (T2). Results: Improvement of hemineglect at T1 and T2 was significantly higher in the PARO group (T1: mean (SD) = 6.23 (3.81); T2: mean (SD) = 7.85 (3.68)) compared to the control group (T1: mean (SD) = 2.66 (4.19); T2: mean (SD) = 3.33 (4.16)) (T1: P < 0.05; T2: P < 0.05). Conclusion: The study showed that the use of the PARO is well accepted and can help to improve neglect symptoms in patients with subacute stroke.

An overview of systematic reviews and meta-analyses of acupuncture for dysphagia post-acute stroke: A protocol

IntroductionThe results of previous systematic reviews (SRs) and meta-analyses on acupuncture for post-acute stroke dysphagia have provided conflicting evidence. This systematic review of overviews will aim to summarize and evaluate the quality of the existing SRs and meta-analyses with the aim of identifying whether acupuncture could provide a therapeutic option to treat patients with dysphagia post-acute stroke. MethodsA systematic search of seven electronic databases (Pubmed, EMBASE, Cochrane library, CNKI, Wanfang, SinoMed and VIP) will be performed according to a predefined search strategy for SRs and meta-analyses of randomized controlled trials (RCTs) and quasi-RCTs on acupuncture for dysphagia post-acute stroke.Two authors will independently select SRs and meta-analyses and collect appropriate data. The reporting quality of included SRs and meta-analyses will be assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The revised Assessment of Multiple Systematic Reviews (AMSTAR 2) will be used to assess the quality of the SRs and meta-analyses. If necessary, GRADE will be used to rate the quality of evidence. ResultsThis overview will identify current SRs and meta-analyses of RCTs or quasi-RCTs of acupuncture treatment for dysphagia post-acute stroke. DiscussionThe current evidence will be evaluated to help answer the question - is acupuncture a potentially effective treatment for dysphagia after stroke?Prospero Registration Number CRD42019134163.

Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors.

To determine the risk factor profiles associated with post-acute ischaemic stroke (AIS) myocardial infarction (MI) over long-term follow-up. This observational study includes prospectively identified AIS patients (n=9840) admitted to a UK regional centre between January 2003 and December 2016 (median follow-up: 4.72years). Predictors of post-stroke MI during follow-up were examined using logistic and Cox regression models for in-hospital and post-discharge events, respectively. MI incidence was determined using a competing risk non-parametric estimator. The influence of post-stroke MI on mortality was examined using Cox regressions. Mean age (SD) of study participants was 77.3 (12.2) years (48% males). Factors associated with in-hospital MI (OR [95% CI]) were increasing blood glucose (1.80 [1.17-2.77] per 10mmol/L), total leucocyte count (1.25 [1.01-1.54] per 10×109 /L) and CRP (1.05 [1.02-1.08] per 10mg/L increase). Age (HR [95% CI]=1.03 [1.01-1.06]), coronary heart disease (1.59 [1.01-2.50]), chronic kidney disease (2.58 [1.44-4.63]) and cancers (1.76 [1.08-2.89]) were associated with incident MI between discharge and one-year follow-up. Age (1.02 [1.00-1.03]), diabetes (1.96 [1.38-2.65]), congestive heart failure (2.07 [1.44-2.99]), coronary heart disease (1.81 [1.31-2.50]), hypertension [1.86 (1.24-2.79)] and peripheral vascular disease (2.25 [1.40-3.63]) were associated with incident MI between 1 and 5years after discharge. Diabetes (2.01 [1.09-3.72]), hypertension (3.69 [1.44-9.45]) and peripheral vascular disease (2.46 [1.02-5.98]) were associated with incident MI between 5 and 10years after discharge. Cumulative MI incidence over 10years was 5.4%. MI during all follow-up periods (discharge-1, 1-5, 5-10years) was associated with increased risk of death (respective HR [95% CI]=3.26 [2.51-4.15], 1.96 [1.58-2.42] and 1.92 [1.26-2.93]). In conclusion, prognosis is poor in post-stroke MI. We highlight a range of potential areas to focus preventative efforts.

A Hybrid Robotic System for Arm Training of Stroke Survivors: Concept and First Evaluation.

To develop and evaluate a hybrid robotic system for arm recovery after stroke, combining ElectroMyoGraphic (EMG)-triggered functional electrical stimulation (FES) with a passive exoskeleton for upper limb suspension. The system was used in a structured exercise program resembling activities of daily life. Exercises execution was continuously controlled using angle sensor data and radio-frequency identification technology. The training program consisted of 27 sessions lasting 30 min each. Seven post-acute stroke patients were recruited from two clinical sites. The efficacy of the system was evaluated in terms of action research arm test, motricity index, motor activity log, and box & blocks tests. Furthermore, kinematics-based and EMG-based outcome measures were derived directly from data collected during training sessions. All patients showed an improvement of motor functions at the end of the training program. After training, the exercises were in most cases executed faster, smoother, and with an increased range of motion. Subjects were able to trigger FES, but in some cases, they did not maintain the voluntary effort during task execution. All subjects but one considered the system usable. The preliminary results showed that the system can be used in a clinical environment with positive effects on arm functional recovery. However, only the final results of the currently ongoing clinical trial will unveil the system's full potential. The presented hybrid robotic system is highly customizable, allows to monitor the daily performance, requires low supervision of the therapist, and might have the potential to enhance arm recovery after stroke.

Economic evaluation of a phase III international randomised controlled trial of very early mobilisation after stroke (AVERT)

ObjectivesWhile very early mobilisation (VEM) intervention for stroke patients was shown not to be effective at 3 months, 12 month clinical and economical outcomes remain unknown. The aim was to...

Left Shifting of Language Related Activity Induced by Bihemispheric tDCS in Postacute Aphasia Following Stroke.

Both anodal transcranial direct current stimulation (tDCS) of the left IFG and cathodal stimulation of the right IFG were shown to improve rehabilitation of stroke patients with Broca’s aphasia. The study aimed at assessing the impact of a bihemispheric IFG stimulation compared to sham on postacute non-fluent aphasia. Twelve patients with non-fluent aphasia were included at least 4 weeks following cerebral stroke. Ten daily sessions of 2 mA bihemispheric verum or sham tDCS (anode on left IFG and cathode on right IFG) were performed concomitantly with individual language therapy in a double-blinded randomized controlled study with parallel group design. Language functions [i.e., communication (ANELT), picture naming and the Aachen aphasia test (AAT)] were assessed up to 1 month following tDCS. The picture naming task significantly improved (increased number of nouns) at the end of the tDCS procedure in the verum but not sham group. Improvements in the picture naming task and the communication task of the AAT at 4 weeks after tDCS procedure were only seen in the verum group. In patients with postacute cerebral stroke, repeated sessions of tDCS applied on both IFG concomitantly with language therapy were able to induce immediate effects on picture naming presumably due to an early left shift of language-associated function that maintained for 4 weeks. Effects on clinically relevant communicative abilities are likely.

Acute cerebellar stroke and middle cerebral artery stroke exert distinctive modifications on functional cortical connectivity: A comparative study via EEG graph theory

ObjectiveWe tested whether acute cerebellar stroke may determine changes in brain network architecture as defined by cortical sources of EEG rhythms. MethodsGraph parameters of 41 consecutive stroke patients (<5 days from the event) were studied using eLORETA EEG sources. Network rearrangements of stroke patients were investigated in delta, alpha 2, beta 2 and gamma bands in comparison with healthy subjects. ResultsThe delta network remodeling was similar in cerebellar and middle cerebral artery strokes, with a reduction of small-worldness. Beta 2 and gamma small-worldness, in the right hemisphere of patients with cerebellar stroke, increase respect to healthy subjects, while alpha 2 small-worldness increases only among patients with a middle cerebral artery stroke. ConclusionsThe network remodeling characteristics are independent on the size of the ischemic lesion. In the early post-acute stages cerebellar stroke differs from the middle cerebral artery one because it does not cause alpha 2 network remodeling while it determines a high frequency network reorganization in beta 2 and gamma bands with an increase of small-worldness characteristics. SignificanceThese findings demonstrate changes in the balance of local segregation and global integration induced by cerebellar acute stroke in high EEG frequency bands. They need to be integrated with appropriate follow-up to explore whether further network changes are attained during post-stroke outcome stabilization.

Intravenous Magnesium Sulfate in Acute Stroke.

Background and Purpose- Acute stroke treatment is challenging, and stroke remains a major cause of death and disability. The purpose of this meta-analysis is to investigate the effects of postacute stroke intravenous administration of the neuroprotectant magnesium sulfate (MgSO4) on global outcome, functional outcome, and mortality 90 days poststroke (ischemic and nonischemic). Methods- We searched in Pubmed, Science Direct, CENTRAL, and ClinicalTrials.gov, up to November 11, 2017, and we conducted a systematic review and meta-analysis of randomized controlled trials. We synthesized results by using random-effects model, weighted mean differences, standardized mean differences, and odds ratios. Results- Seven randomized controlled trials (4347 patients) met our criteria. Compared with placebo, treatment did not improve functional outcome defined as Barthel Index >60 (odds ratio =1.05; 95% CI, 0.92-1.19) and >95 (odds ratio =0.95; 95% CI, 0.76-1.20), 90 days poststroke. It also did not improve global outcome measured with modified Rankin Scale (standardized mean difference =-0.01; 95% CI, -0.12 to 0.10), 90 days poststroke. In an additional subgroup meta-analysis that exclusively included ischemic stroke patients, intravenous MgSO4 resulted in lower modified Rankin Scale score (improved global outcome; weighted mean difference =-0.96; 95% CI, -1.34 to -0.58; I2=0%], 90 days poststroke. Finally, mortality stayed unaltered (odds ratio =1.10; 95% CI, 0.94-1.29). Conclusions- The findings of our meta-analysis showed that intravenous MgSO4 generally did not improve global/functional outcomes and mortality at 90 days after stroke (combined ischemic stroke and nonischemic stroke). The finding of favorable neurological outcome, selectively in ischemic stroke patients, should be viewed with extreme caution given the limited number of patients included in this subgroup meta-analysis.

Correction: Acute post stroke depression at a Primary Stroke Center in the Middle East

[This corrects the article DOI: 10.1371/journal.pone.0208708.].

Abstract TP360: Does Weekend Admission for Intravascular Thrombolysis Post-Acute Ischemic Stroke Associated With Worse Short-Term Outcomes? A 5-Years Us Experience

Background: No large-scale study available to establish ‘weekend effect’ of higher in-hospital mortality and 30-day readmissions after admission for post-Acute ischemic stroke (AIS) thrombolysis. Our objective was to determine short term outcomes and its trends associated with weekend vs weekday index hospitalization. Methods: Nationwide Readmissions Database (NRD) from 2010-14 was utilized to identify AIS using appropriate ICD-9CM codes in primary diagnosis fields. IVT was identified by ICD9 procedure code 99.10 in any procedural field. HCUP variable “aweekend” was used to identify weekend vs weekday admission and Cochrane-Armitage test was used to generate p value. Results: We identified 164,007 AIS patients undergoing IVT (Mean age=69.5 years,49.6% Female). Weekend admission (6,229 in 2010 to 11,156 in 2014) were associated with increasing trends of hospitalization for thrombolysis with a relative change of 78%. Weekend admissions were associated with overall higher 30-day readmissions (11.03% vs 10.8%), with decreasing trend from 11.5% (vs 12% weekdays) in 2010 to 10.5% (vs 10.3% weekdays) in 2014 with a relative decrease of 8.1% (vs 16.5%- weekdays) (p&lt;0.001). Weekend admissions were associated with overall higher in hospital mortality 9.2% vs 9.03% as compared to weekdays, though exhibiting a decline from 10.9% to 7.5% (relative change -32.5%, p&lt;0.001). Weekend admissions were associated with overall lower cost of hospitalization 25,929$ vs 26,523$ as compared to weekdays, though exhibiting a decline from 27,215$ to 24,613$ (relative change -10.5%, p&lt;0.001). There is no significant difference in length of stay between weekend vs weekday admission (9days vs 9 days). Conclusion: Our study showed that weekend admissions for AIS patients undergoing IVT are associated with higher in-hospital mortality, 30-day readmission and lower cost of hospitalization. We speculate that better access of care on weekends will improve then outcome for patients getting IVT and reduce the healthcare burden associated with readmissions.

Abstract TP33: Diminished Likelihood of Favorable Stroke Outcomes Following Endovascular Therapy in Octogenarians

Introduction: While data from randomized controlled trials suggest an overall benefit of endovascular therapy (EVT) in older patients suffering from anterior circulation large vessel occlusion (acLVO), real world evidence is lacking. We aimed to explore the likelihood of achieving favorable stroke outcomes in octogenarians undergoing EVT for acLVO. Methods: We prospectively studied consecutive ischemic stroke patients aged 80 years or older who were considered for EVT due to acLVO at our tertiary stroke center (01/2016-06/2018). We compared clinical characteristics and efficacy outcomes including 90-days functional independence (i.e., mRS scores 0-2) and 90-days survival among patients who underwent EVT and those who did not undergo EVT. A multivariable regression model was built to identify predictors of favorable outcomes. Results: In total, 185 patients aged 80 years or older were prospectively screened for EVT eligibility during the 30-months study period: median age was 84 years (interquartile range, 82-88); 30% were men; median NIHSS score was 18 (interquartile range, 14-21) points. Of these patients, 97 (52.4%) were eventually treated for proximal acLVO. The main reasons to withhold EVT were large infarct size (54.6%) and recanalization (30.7%), followed by unknown time window (5.7%), lack of perfusion mismatch or collaterals (4.5%) and early clinical improvement (2.3%). No differences according to vascular risk factors, baseline imaging and clinical variables were evident among both groups. There was a non-significant trend toward survival (50.6% versus 37.3%, p=0.09) but not functional independence (9.9% versus 5.3%, p=0.39) at 90 days in patients who underwent EVT compared with the non-EVT group. In the multivariable model, favorable outcomes were not predicted by pre-stroke disability, stroke severity, infarct size or treatment with intravenous tPA. Conclusions: While age alone should not exclude patients from endovascular therapy, diminished likelihood of favorable outcomes may challenge postacute stroke care in octogenarians.