Predictor Of Functional Outcome Research Articles

Symptoms, Imaging Features, Treatment Decisions, and Outcomes of Patients with Top of the Basilar Artery Syndrome: Experiences from a Comprehensive Stroke Center.

From visual, ocular, and pupillomotor abnormalities to qualitative and more importantly rapid quantitative disturbances of consciousness, top of the basilar artery syndrome (TOBS) represents a diagnostic challenge in neurocritical care. In this monocentric retrospective cross-sectional study, we will describe this particular patient group in detail and highlight its variability and the associated implications. Consecutive patients with radiologically confirmed TOBS presenting to our comprehensive stroke center were analyzed from 2010 to 2022. Baseline parameters at admission, including clinical symptoms, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, and imaging parameters (mode and success of recanalization measured by the Thrombolysis in Cerebral Infarction [TICI] score, extent of infarct, and infarct localization), were assessed. Functional dependence at discharge was analyzed with the modified Rankin scale (mRS) and Barthel Index. We assessed 96 eligible patients with a mean age of 70 (SD ± 14) years, 41.67% of whom were female. The median NIHSS score at admission was 19 (interquartile range [IQR] 8-35), and the median GCS score was 7 (IQR 3-15). Dysphagia was identified in 51.72% of patients, with a significant number discharged with nasogastric tubes. Most patients received both intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) (47%), whereas 32% received MT only, and 10% received no acute recanalizing therapy. Patients receiving both IVT and MT had higher frequencies of successful vessel revascularization (higher TICI scores) and better clinical outcomes compared to those receiving only MT (median mRS score 4 [IQR 2-5] vs. 5 [IQR 2-6], p = 0.046). Multivariable regression analysis confirmed that successful recanalization (TICI) and GCS score at admission were key predictors of functional outcomes. A large proportion of patients presenting with TOBS were severely affected by a significant reduction in vigilance, a condition that persists in the absence of recanalization and is then associated with a relevant dependency.

Predictors and outcomes of angioplasty and stenting in acute intracranial atherosclerosis-related vertebrobasilar artery occlusion

ObjectiveThis study aimed to investigate clinical outcomes and predictors of favorable functional outcomes after endovascular treatment, including emergent angioplasty and stenting, in patients with intracranial atherosclerotic stenosis (ICAS)-related occlusions in vertebrobasilar arteries.Materials and methodsThis retrospective case series included 46 patients with acute occlusions of vertebrobasilar arteries, due to underlying ICAS. All patients underwent a thrombectomy, followed by angioplasty and/or stenting. We performed logistic regression analyses to identify independent predictors of favorable outcomes. A favorable outcome was defined as a score of 0–3 on the 90-day modified Rankin Scale.ResultsOverall, successful reperfusion was achieved in 44/46 (95.7%) patients and 90-day favorable outcomes were achieved in 21/46 patients (45.7%). The 90-day mortality rate was 23.9% (11/46). In a multivariate binary logistic analysis, independent predictors of favorable outcome were hyperlipidemia (OR = 7.866, 95% CI: 1.093–56.590, p = 0.040), admission hyperglycemia (OR = 0.144, 95% CI: 0.023–0.914, p = 0.040), basilar artery occlusion (OR = 0.086, 95% CI: 0.008–0.907, p = 0.041), and treatment with angioplasty alone (OR = 9.779, 95% CI: 1.022–93.525, p = 0.048).ConclusionOur findings suggested that emergent angioplasty and/or stenting could yield high rates of successful reperfusion and favorable outcomes in patients with ICAS-related occlusions in vertebrobasilar arteries. Our study also demonstrated that hyperlipidemia and treatment with angioplasty alone were associated with favorable outcomes, in contrast, admission hyperglycemia and basilar artery occlusion were associated with unfavorable outcomes in these patients.

Automated assessment of collateral circulation and infarct core: predictors of functional outcomes in acute ischemic stroke following endovascular thrombectomy.

This study aimed to evaluate the predictive value of automatically assessed collateral circulation (CC) and infarct core for functional outcome in acute ischemic stroke (AIS) patients treated with endovascular thrombectomy (EVT). We conducted a retrospective cohort study of 208 patients with anterior large vessel occlusion treated with EVT. Two AI-powered software were used to automatically assess CC and infarct core. Comparative analyses included patient demographics, clinical and imaging data, and functional outcome. Univariate and multivariable logistic regression analyses were conducted to predict the 90-day functional outcome. A favorable outcome was defined as a modified Rankin scale (mRS) score ≤ 2. Among the 208 patients, 114 (54.8%) were women and 94 were men, with a mean age of 71.4 ± 13.3 years. Patients with higher collateral score (CS) exhibited lower infarct core volumes (p < 0.001) and better mRS score at 90 days (p = 0.008). Among patients with a favorable outcome, the mean infarct core volume was lower compared to those with poor outcomes (5 mL vs. 8.6 mL, p = 0.003). In univariate logistic regression, both infarct core (OR 0.94, p = 0.005) and CS (OR 1.84, p = 0.014) were predictors of favorable outcome. However, in multivariable models, only infarct core remained a significant independent predictor [AORs of 0.95 (p = 0.021) and 0.96 (p = 0.039)]. Automatically assessed infarct core is a robust predictor of functional outcome in AIS patients post-EVT, while CS's predictive value diminishes when adjusted for infarct core. These findings support the integration of AI-powered evaluations in clinical settings to improve prognosis and treatment strategies for AIS.

Renal Function After Partial Nephrectomy: A Comparative Analysis of Warm, Cold, and No Ischemia Methods.

Results from prior studies show contradictory evidence in determining whether utilization of renal ischemia during partial nephrectomies (PN) results in worse renal functional outcomes. Data assessing a large cohort of patients with no ischemia PN are lacking. The purpose of this study was to evaluate whether the use and type of renal ischemia during PN affects renal functional outcomes. A retrospective review of 742 patients undergoing PN were assessed and split into 4 cohorts: no ischemia (n = 455), cold ischemia (n = 63), warm ischemia time (WIT) < 30 minutes (n = 164), and WIT ≥ 30 minutes (n = 60). Twelve-month relative glomerular filtration rate (GFR) changes and split function were assessed among the cohorts. Univariate and multivariable regression analysis were used to determine predictors of postoperative acute kidney injury and long-term renal functional outcomes. No difference in the mean relative decrease in GFR was noted among the 4 cohorts at either the 3-month (8.7% ± 25.5, P = .1) or 12-month (7.5% ± 19.0, P = .2) period. On multivariable analysis, age (coef: 0.3, P < .001), estimated blood loss (coef: 0.2 per 100 mL, P = .02), baseline GFR (coef: 2 per 10 units, P < .001), number of tumors resected (coef: 0.4, P = .02), and postoperative acute kidney injury (coef: 8.3, P < .001) were predictive of a higher percentage decrease in 12-month GFR while male sex (coef: -6.3, P = .001) was inversely related. The type of ischemia or length of WIT was not associated with 12-month GFR change. In patients undergoing PN, the use of and type of ischemia affects short-term but not long-term renal functional outcomes. Facility with multiple ischemia techniques may be useful in the management of patients requiring complex PN.

Emotional intelligence as a predictor of functional outcomes in psychotic disorders.

Psychotic disorders are associated with significant impairment in psychosocial functioning, yet mechanisms associated with this impairment remain poorly understood. Emotional intelligence, a component of social cognition, is associated with psychosocial functioning in this population. However, prior work has used relatively small samples, reported inconsistent relations between functioning domains and emotional intelligence, and inconsistently considered negative symptoms. To address these limitations, we examined the predictive ability of emotional intelligence on functional outcomes using a five-year longitudinal design. We used a large sample of individuals with and without psychotic disorder diagnoses (N=324), a performance-based measure of emotional intelligence, and three measures of functioning (i.e., social performance, assessor-rated social and occupational functioning, self-rated functioning in independent living). Results revealed individuals diagnosed with a psychotic disorder have lower emotional intelligence than those without a history of psychosis. Emotional intelligence was associated with social performance and social and occupational functioning in both those with and without a history of psychosis. In those diagnosed with a psychotic disorder, emotional intelligence and negative symptoms better predict social performance (βEmotional=0.36, R2delta=0.09) and social and occupational functioning (βEmotional=0.21, R2=0.03), but not self-rated functioning in independent living (βEmotional=-0.08, R2delta=0.00), as compared to negative symptoms alone. Overall, findings support the use of emotional intelligence as a longitudinal predictor of social and occupational outcomes above and beyond negative symptoms alone. This work highlights potential, specific intervention targets for individuals with psychotic disorders.

Abstract TMP78: Beyond Recanalization: Predicting Poor Outcomes in Successful Vertebrobasilar Thrombectomy

Background: Successful recanalization following endovascular thrombectomy (EVT) in vertebrobasilar artery occlusions (VBAOs) does not uniformly translate into favorable functional outcomes. Identifying predictors of futile recanalization is critical for improving patient selection and treatment strategies. This study aimed to compare patients with good versus poor functional outcomes despite successful recanalization in VBAO and to establish predictive factors for futile recanalization. Methods: We retrospectively analyzed patients who achieved successful recanalization after EVT for VBAO from a prospectively maintained database between 2014-2024. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days; dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcomes. Demographic data, clinical characteristics, procedural variables, and imaging findings were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify predictors of futile recanalization. Results: Among the 163 patients who qualified for final analysis, 73 (44.8%) had good functional outcomes, while 90 (55.2%) had poor outcomes despite successful recanalization. Age (72 years vs. 64 years, p=0.0014), baseline NIHSS score (22 vs. 14, p&lt;0.0001), and serum glucose levels (142 mg/dL vs. 124 mg/dL, p=0.0109) were significantly higher in patients with poor outcomes. In addition, intubation (57.1% vs. 25.4%, p&lt;0.001) and prior history of diabetes mellitus (34.4% vs. 17.8%, p=0.017) and coronary artery disease (33.3% vs. 16.4%, p=0.014) were more prevalent in the poor outcome group. Multivariable analysis confirmed that advanced age (OR 0.73, 95% CI: 0.57-0.93, p=0.012), higher serum glucose (OR 0.90, 95% CI: 0.82-0.99, p=0.025), NIHSS at 24-36 hours post-last known well (OR 0.61, 95% CI: 0.38-0.98, p=0.039), and mRS at discharge (OR 0.0001, 95% CI: 0.0002-0.064, p=0.005) were independent predictors of poor functional outcomes, indicating futile recanalization. A subgroup analysis of patients with complete recanalization (mTICI 2c/3) further validated these findings. Conclusion: Futile recanalization after EVT for VBAO is linked to older age, elevated serum glucose levels, higher NIHSS scores at 24-36 hours, and poor mRS at discharge. These factors should be carefully considered in clinical decision-making to improve patient selection for EVT in VBAO.

Abstract 12: High HDL Cholesterol Is Associated With Reduced Reperfusion Injury And Favorable Functional Outcome Following Thrombectomy For Ischemic Stroke

Introduction: Animal research suggests that HDL cholesterol (HDL-C) ameliorates reperfusion injury, a phenomenon that worsens clinical outcome following recanalization therapy for ischemic stroke. Hypothesis: We hypothesized that higher HDL-C levels have a guarding effect against cerebral reperfusion injury in human stroke survivors treated with thrombectomy. Methods: We included patients with anterior circulation large vessel occlusion (acLVO) stroke who underwent thrombectomy from 01/2017 to 01/2023 at a tertiary stroke center in Germany into a prospective registry study with retrospective analysis. We assessed the association of HDL-C serum levels and imaging indices of post interventional reperfusion injury (any intracerebral or subarachnoid bleeding involving the ischemic brain region on CT or MRT), functional outcome quantified via modified Rankin scale (mRS) at 90 days and neurological outcome via National Institutes of Health Stroke Scale (NIHSS) score at discharge using multivariable lasso logistic and linear regression adjusted for demographic, clinical and imaging characteristics. We performed sensitivity analysis applying propensity score matching and shift analysis using ordered logistic regression. Results: In our study population of 811 acLVO patients treated with thrombectomy (420 females, median age 77 years [66-84, interquartile range]) reperfusion injury was associated with detrimental functional outcome (adjusted OR 2.87; 95% CI [1.86;4.41]; p=0.000). Higher HDL-C was associated with lower odds of reperfusion injury (adjusted OR 0.57; 95% CI [0.35;0.95]; p=0.03) and emerged as predictor of favorable functional outcome defined as 90-day mRS 0-2 (adjusted OR 0.57; 95% CI [0.34;0.99]; p=0.04) and alleviated neurological deficits with lower NIHSS score at discharge (ß=-2.51; 95CI% [-4.88; -1.30]; p=0.04). On propensity score analysis an HDL-C level exceeding the median (1.15 mmol/L) was associated with a 13.8 % decrease in the probability of reperfusion injury (ß=-0.14; 95CI% [-0.23; -0.05]; p=0.003). A significant shift of 90-day mRS distribution favoring high HDL is shown in the figure. Conclusions: In patients undergoing thrombectomy for acLVO a higher level of HDL-C reduced the odds of reperfusion injury, which translated into improved functional and neurological outcome, hence constituting a possible target of adjunctive neuroprotective treatment.

Abstract TMP60: Using CTP based Disconnectome Mapping to identify optimal candidates for endovascular treatment in acute ischemic stroke.

Background: Identifying optimal candidates for endovascular treatment (EVT) remains an ongoing priority to maximize treatment efficacy. The recent large core trials have called into question the use of infarct volume alone for selecting patients. This study aimed at exploring the feasibility of using routinely acquired Computed Tomography Perfusion (CTP) to capture how lesion location impacts brain connectivity and how this in turn affects the ability to benefit from EVT. Methods: Consecutive patients from a multi-centric stroke imaging registry were included in this study if they had a proven anterior circulation large vessel occlusion (LVO) and available baseline CTP data. Hypoperfusion (Tmax &gt;6 seconds) and ischemic core (relative cerebral blood flow &lt;30%) maps were automatically generated using e-CTP (Brainomix, UK) and used to derive disconnection maps via a DTI template. A voxel-based, multivariate method (Sparse Canonical-Correlation-Analysis – LESYMAPS) was used to explore associations between disconnection maps and NIHSS subitems in recanalized patients. The mismatch between Tmax and core disconnection volumes (disconnection mismatch volume) (Figure 1) was used to predict modified Rankin Scale (mRS) at 3-months using an ordinal shift regression adjusted for age, recanalization status and infarct volume. Results: One-hundred and seventy-one patients were included. The median NIHSS was 16 (11.5 to 22). The total NIHSS was associated with disconnection predominantly within the left basal ganglia, brainstem and corpus callosum. Upper and lower limb deficits (NIHSS 5a, 5b, 6a, 6b) were associated with corticospinal tract disconnection, with negative correlations within the contralateral tracts (Figure 2). Language deficits were associated with left hemisphere tract disconnection, also showing negative correlations within the contralateral tracts. The disconnection mismatch volume was an independent predictor of functional outcome at 3-months (Table 1). Conclusion: The results from this study showed that it is possible to use routinely acquired CTP to capture the effects of stroke lesion on brain connectivity and its impact on functional outcome following recanalization treatment. Such an approach could enable more nuanced treatment selection for patients based on specific neurological deficits.

Abstract TP335: Machine learning model for prediction of functional outcome in patients with recent small subcortical infarction.

Objective: Approximately 10%-17% of patients with a recent small subcortical infarction (RSSI) experience an adverse functional prognosis at three months. Identifying risk factors for poor prognosis in these patients and developing a predictive model are of significant clinical relevance. Methods: We conducted a prospective cohort study involving 630 patients with recent small subcortical infarction (RSSI). These patients were divided into training (70%) and internal validation (30%) cohorts. Additionally, for external validation, 103 patients from two other hospitals were included. To predict functional outcomes at three months, we employed eight different machine learning algorithms: Support Vector Machine, Decision Tree, Random Forest, Gradient Boosting, Extreme Gradient Boosting, Light Gradient Boosting Machine, Cat Boosting, and Logistic Regression. The interpretability of the best-performing model was enhanced with SHapley Additive exPlanations(SHAP). Results: Among the 630 patients included in the study, the average age of participants was 59.0 ±13.0 years and 65 (10.3%) exhibited poor functional outcomes at three months. The Cat Boosting model showed the highest performance among eight machine learning models. The final model could accurately predict outcome in both internal (AUC = 0.968) and external (AUC = 0.856) validations. SHAP analysis indicated that the initial NIHSS score was the most important variable. The web application is available at https://yrssiml.streamlit. app. Conclusions: Our research developed a predictive model using the Cat Boosting algorithm to forecast poor functional outcomes at three months in patients with RSSI. This model enables clinicians to identify patients at high risk and implement targeted interventions more effectively.

Endovascular Treatment for Tentorial Dural Arteriovenous Fistulas: A Retrospective Single-Center Study.

Current evidence suggests that tentorial dural arteriovenous fistulas with endovascular treatment offer a high rate of occlusion and reduced procedural risks. Here we report the clinical and angiographic outcomes in patients with tentorial dural arteriovenous fistulas who underwent endovascular treatment as first-line treatment. A retrospective analysis was conducted on 83 patients with tentorial dural arteriovenous fistulas treated at our center from April 2009 to November 2023 using endovascular treatment. Patient demographics, clinical presentation, angiographic, treatment results, and follow-up outcomes were registered. Univariable and multivariable logistic regression were performed to identify onset of intracranial hemorrhage predictors, procedure-related complications predictors and predictors of poor functional outcome. Eighty-three patients underwent endovascular treatment as first-line treatment. Most patients (80.7%) were symptomatic and a total of 25 patients (30.1%) presented with intracranial hemorrhage. Presence of deep venous drainage and midline location was associated with a lower incidence of intracranial hemorrhage. Middle meningeal artery (57.8%, 48/83) and pial artery (15.7%, 13/83) were the most frequently used access routes for embolization. A total of 74 (89.1%) TDAVFs were completely occluded after the last EVT session immediately. Complications occurred in 11 patients (13.3%). Six-month angiographic follow-up was performed in 68 patients (81.8%), and 91.2% (62/68) tentorial dural arteriovenous fistulas were occluded. At clinical follow-up (100%, 83/83), good functional outcome (mRS 0-2) was documented in 74 (89.1%) patients. Logistic regression analysis identified baseline mRS 3-5 as the most significant independent predictor of poor functional outcome. Subgroup analysis showed no statistically significant differences in baseline characteristics, angiographic and clinical results between patients treated with targeted pial artery embolization and non-targeted pial artery embolization. Endovascular treatment is a safe and effective primary modality for managing tentorial dural arteriovenous fistulas, achieving high rates of complete angiographic occlusion and favorable functional outcomes. Transarterial embolization, predominantly via middle meningeal artery, was the mainstay of treatment. In patients with pial arterial feeders, omitting aggressive embolization did not compromise efficacy or increase complications. DAVF = dural arteriovenous fistula; TDAVF = tentorial dural arteriovenous fistula; EVT = endovascular treatment; TAE = transarterial embolization; TVE = transvenous embolization; MMA = middle meningeal artery.

Risk factors, mechanisms, and clinical outcomes of stroke in young adults presenting to a North Central London stroke service: UCL Young Stroke Systematic Evaluation Study (ULYSSES).

Stroke incidence in younger adults is increasing worldwide yet few comprehensive studies exist from a UK population. We investigated the risk factors, mechanisms, functional outcome and stroke recurrence rate in a cohort of young adults with stroke. We included consecutive patients (<55 years) with ischaemic stroke or intracerebral haemorrhage (ICH) admitted to the University College London Hospitals Hyperacute Stroke Unit between 2017 and 2020. Ischaemic stroke was classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria and ICH using modified CLAS-ICH criteria. Multivariable logistic regression was performed to identify predictors of unfavourable functional outcome (modified Rankin Scale [mRS] > 1) at 6 months. Five hundred fifty-two patients were included (median age 47, IQR 41-51; 33% female; 76% ischaemic stroke). Common risk factors included dyslipidaemia (57%), hypertension (40%), and cigarette smoking (34%). Ischaemic stroke was mostly due to cardioembolism (22%). Probable cerebral small vessel disease was the most frequent ICH aetiology (53%). Unfavourable functional outcome was prevalent in 50% at 6 months and was associated with ICH (OR 2.02, 95%CI 1.14-3.58, p = 0.017), female sex (OR 1.62, 95%CI 1.03-2.55, p = 0.037), admission stroke severity (per point increase, OR 1.11, 95%CI 1.07-1.16, p < 0.001) and pre-morbid mRS 2-5 (OR 3.16; 95%CI 1.11-9.03, p = 0.032). 4.4% had a recurrent stroke within 6 months. Traditional cardiovascular risk factors are common in young adults with stroke. Unfavourable functional outcome is associated with female sex, ICH, severe stroke and pre-morbid disability. These findings can inform national stroke prevention and rehabilitation strategies.

Interpretable machine learning model for outcome prediction in patients with aneurysmatic subarachnoid hemorrhage

BackgroundAneurysmatic subarachnoid hemorrhage (aSAH) is a critical condition associated with significant mortality rates and complex rehabilitation challenges. Early prediction of functional outcomes is essential for optimizing treatment strategies.MethodsA multicenter study was conducted using data collected from 718 patients with aSAH who were treated at five hospitals in Japan. A deep learning model was developed to predict outcomes based on modified Rankin Scale scores using pretherapy clinical data collected from admission to the initiation of physical therapy. The model’s performance was assessed using the area under the curve, and interpretability was enhanced using SHapley Additive exPlanations (SHAP). Logistic regression analysis was also performed for further validation.ResultsThe area under the receiver operating characteristic curve of the model was 0.90, with age, World Federation of Neurosurgical Societies grade, and higher brain dysfunction identified as key predictors. SHAP analysis supported the importance of these features in the prediction model, and logistic regression analysis further confirmed the model’s robustness.ConclusionsThe novel deep learning model demonstrated strong predictive performance in determining functional outcomes in patients with aSAH, making it a valuable tool for guiding early rehabilitation strategies.

Association of thrombus enhancement with mortality following endovascular therapy in patients with acute anterior circulation stroke

BackgroundThrombus enhancement sign (TES) has emerged as a potential imaging biomarker in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT).ObjectiveTo evaluate the prognostic value of TES on 90-day...

Functional outcome prediction in Japanese patients with non-surgical intracerebral hemorrhage: The FSR ICH Score.

There has been limited research on predicting the functional prognosis of patients with non-surgical intracerebral hemorrhage (ICH) from the acute stage. The aim of this study is to develop a risk prediction model for the natural course in patients with non-surgical ICH and to evaluate its performance using a multicenter hospital-based prospective study of stroke patients in Japan. We consecutively registered a total of 1,017 patients with acute ICH (mean age, 68 years) who underwent conservative treatment and followed them up for 3 months. The study outcome was a poor functional outcome (modified Rankin Scale score, 4-6) at 3 months after ICH onset. To develop the risk prediction model for natural course in patients with non-surgical ICH, we included the following clinical common factors assessed on admission in daily clinical practice for ICH: age, sex, medical history (hypertension, diabetes mellitus, dyslipidemia, pre-stroke dementia, previous stroke, coronary artery disease, smoking status, alcohol drinking status, oral anticoagulation, and antiplatelet medication), admission status (Time from onset to admission, systolic blood pressure, diastolic blood pressure, pulse pressure, plasma glucose levels, severity of the stroke), and neuroradiologic data (ICH location, intraventricular hemorrhage, and hematoma volume).The risk prediction model for poor functional outcome was developed using logistic regression analysis. In addition, the risk prediction model was translated into a point-based simple risk score (FSR ICH score) using the approach in the Framingham Heart Study. At 3 months after the ICH onset, 323 (31.8%) patients developed a poor functional outcome. Age, diabetes mellitus, pre-stroke dementia, NIHSS score on admission, intraventricular hemorrhage, and hematoma volume were included in the risk prediction model. This model demonstrated excellent discrimination (C statistic=0.884 [95% confidence interval, 0.863-0.905]; optimism-corrected C statistic based on 200 bootstrap samples=0.877) and calibration (Hosmer-Lemeshow goodness-of-fit test: P=0.72). The FSR ICH score, a point-based simple risk score, also showed excellent discrimination, with a C statistic of 0.882 (95% CI: 0.861-0.903). We developed a new risk prediction model for 3-month poor functional outcome in patients with non-surgical ICH using a multicenter hospital-based prospective study in Japan. The current risk prediction model has the potential to be a useful tool for estimating the natural course in patients with non-surgical ICH, aiding in making treatment decisions, including surgical options, early formulation of rehabilitation plans, and efficient utilization of medical resources.

Secondary Subtalar Arthrodesis: Surgical Outcome and Predictors of Functional Outcome and Quality of Life After Bone Block Distraction vs In Situ Technique.

The outcome of a secondary subtalar arthrodesis after prior calcaneal fracture has been widely described. However, the surgical treatment has evolved significantly over the past decade, paralleling the shifts observed in primary repair strategies. Therefore, we describe the outcome following a secondary arthrodesis after an intra-articular calcaneal fracture, comparing the in situ (ISA) and bone block distraction arthrodesis (BBDA) techniques. In total, 339 patients who underwent a subtalar arthrodesis between January 1998 and November 2022 were screened for eligibility. Inclusion criteria were age ≥16 years, having undergone a subtalar arthrodesis following a calcaneal fracture, and a minimal follow-up of 1 year. Exclusion criteria were subtalar arthrodesis before January 2010 and a subtalar arthrodesis within 6 weeks of injury. A total of 259 patients did not meet the inclusion criteria, resulting in the inclusion of 80 patients with 82 fractured calcanei. No significant differences between ISA and BBDA in surgical outcome were seen. Subtalar fusion was achieved in 78 of the patients (95.1%). Additionally, a deep surgical site infection occurred in 6 patients (7.8%). The American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS) and Foot Function Index (FFI) scores and the EuroQol-5 dimensions (EQ5D) index were similar between the 2 groups. However, a significantly higher EQ5D-VAS was reported by the subjects who received a BBDA (median [interquartile range], 70.0 [52.0-82.0] vs 81.0 [70.0-90.3], P = .021). Multiple regression revealed that a higher Böhler angle before the initial fracture reconstruction significantly improved the AOFAS score, whereas the FFI significantly improved by an initial conservative treatment and implant removal after arthrodesis. Finally, increasing age significantly improved the EQ5D index. Our study presents comparable surgical outcomes between ISA and BBDA for secondary subtalar arthrodesis following calcaneal fractures. Functional outcomes, as measured by the AOFAS and FFI scores, were also similar between the 2 techniques, although patients undergoing BBDA reported higher EQ5D visual analog scale scores. Level III, retrospective cohort study.

Functional Outcomes Following Injury in Pediatric Patients without Traumatic Brain Injury

BackgroundPediatric trauma patients often have disability after successful resuscitation for hemorrhage. Clinical characteristics related to dependency on living following injury were elucidated among pediatric patients without traumatic brain injury. MethodsThis retrospective cohort study used the 2019–2021 Japan Trauma Data Bank and included pediatric patients aged ≤16 years without head injury (Abbreviated Injury Scale [AIS] ≥ 2). The unfavorable function was defined as dependency in daily life at discharge (Glasgow Outcome Scale ≤ 3), and predictors for unfavorable functional outcomes were examined using a generalized estimating equations (GEE) model, including age, sex, physical disability before injury, injury mechanism, transportation time, prehospital procedures, vital signs on arrival, surgery in each body region, transfusion, AIS in each region, and institutions. Furthermore, these factors were analyzed separately in toddler/preschool (≤5 years), school age (6–11 years), and adolescence (12–16 years). ResultsAmong 1,412 patients eligible for the study, 137 had an unfavorable physical function at discharge. The GEE model revealed that female sex, physical disability before injury, prehospital transfusion, lower Glasgow Coma Score (GCS) score on arrival, neck surgery, and higher AIS in the neck and extremity/pelvis were independently associated with unfavorable function at discharge. In age-specific analyses, physical disability before injury strongly predicted worse functional outcomes in toddlers/preschoolers, whereas higher AIS in the chest and lower systolic blood pressure on arrival were additional predictors of dependent living among adolescents. ConclusionsSevere neck/extremity/pelvis injury and lower GCS on arrival are associated with unfavorable functional outcomes in patients with pediatric trauma.

The challenge of long-term stroke outcome prediction and how statistical correlates do not imply predictive value.

Personalized prediction of stroke outcome using lesion imaging markers is still too imprecise to make a breakthrough in clinical practice. We performed a combined prediction and brain mapping study on topographic and connectomic lesion imaging data to evaluate (i) the relationship between lesion-deficit associations and their predictive value and (ii) the influence of time since stroke. In patients with first-ever ischaemic stroke, we first applied high-dimensional machine learning models on lesion topographies or structural disconnection data to model stroke severity (National Institutes of Health Stroke Scale 24 h/3 months) and functional outcome (modified Rankin Scale 3 months) in cross-validation. Second, we mapped the topographic and connectomic lesion impact on both clinical measures. We retrospectively included 685 patients [age 67.4 ± 15.1, National Institutes of Health Stroke Scale 24 h median(IQR) = 3(1; 6), modified Rankin Scale 3 months = 1(0; 2), National Institutes of Health Stroke Scale 3 months = 0(0; 2)]. Predictions for acute stroke severity (National Institutes of Health Stroke Scale 24 h) were better with topographic lesion imaging (R² = 0.41) than with disconnection data (R² = 0.29, P = 0.0015), whereas predictions at 3 months (National Institutes of Health Stroke Scale/modified Rankin Scale) were generally close to chance level. In the analysis of lesion-deficit associations, the correlates of more severe acute stroke (National Institutes of Health Stroke Scale 24 h > 4) and poor functional outcome (modified Rankin Scale 3 months ≥ 2) were left-lateralized. The lesion location impact of both variables corresponded in right-hemisphere stroke with peaks in primary motor regions, but it markedly differed in left-hemisphere stroke. Topographic and disconnection lesion features predict acute stroke severity better than the 3-months outcome. This suggests a likely higher impact of lesion-independent factors in the longer term and highlights challenges in the prediction of global functional outcome. Prediction and brain mapping diverge, and the existence of statistically significant associations-as here for 3-months outcomes-does not imply predictive value. Routine neurological scores better capture left- than right-hemispheric lesions, further complicating the challenge of outcome prediction.

Correlation of Central Column Diaphyseal Angle, Humeral Head Height, Greater Tuberosity to Articular Surface Distance, Age and Fracture Pattern with Constant Murley Score Functional Outcomes in Post-ORIF PHILOS Patients with Proximal Humerus Fracture

Introduction: Proximal humerus fractures (PHF) are common injuries, particularly in the elderly population, caused by both direct and indirect trauma. The Proximal Humerus Internal Locking System (PHILOS) is a widely used treatment for displaced or complex PHF. To assess shoulder function, the European Society for Surgery of the Shoulder and the Elbow recommends the Constant–Murley Score (CMS) as a reliable tool for evaluating shoulder joint outcomes. Materials and Methods: This cross-sectional study was conducted at RSUP Prof I.G.N.G. Ngoerah, Denpasar, Bali, between May 2024 and July 2024. Descriptive analysis was used to determine patient characteristics. The relationships between Central Column Diaphyseal Angle (CCDA), Humeral Head Height (HHH), Greater Tuberosity to Articular Surface Distance (GT-ASD), and CMS were analyzed using Pearson correlation for normally distributed data and Spearman correlation for non-normal data. Results: Statistically significant relationships were found between CCDA, HHH, and GT-ASD with the CMS in patients who underwent ORIF PHILOS for proximal humerus fractures (r=0.915; p&lt;0.001). A significant correlation was also observed between fracture pattern and CMS outcomes. However, age did not show a significant relationship with CMS. Conclusion: CCDA with a cutoff of 109.5 degrees was identified as a primary predictor of functional outcomes. HHH and GT-ASD were also significant, indicating the importance of anatomical restoration for shoulder function recovery. Age did not affect CMS outcomes, emphasizing that the quality of anatomical reconstruction is more critical than age in predicting functional recovery post-surgery. Keywords: CCDA, HHH, GT, AS, Fracture Pattern, Constant Murley Score

Early neuropsychological screening and long-term functional outcome in a sample of patients affected by mild stroke: The ReSCog Project.

Stroke causes severe long-term disabilities with a significant reduction in quality of life. This study aims to explore the predictive value of cognitive screening in the acute phase of mild stroke on patients' functional outcome after discharge. A total of 110 patients with mild stroke were recruited. Patients were included in the study if they were discharged directly home from the acute units. The cognitive profile of patients was assessed with the Oxford Cognitive Screen (OCS). The OCS was administered 3-10 days after stroke, providing a five domain-specific cognitive profile. Long-term functional outcomes were evaluated by the Stroke Impact Scale 3.0 (SIS 3.0), a self-reported questionnaire that includes physical, cognitive, emotional and social participation dimensions. All patients completed the survey online on average 10 months after stroke. Our results show that OCS is positively associated with physical and cognitive dimensions, after adjusting for age and stroke severity measured by NIHSS at admission. In conclusion, OCS in acute mild stroke seems to be an independent predictor of long-term functional outcomes and could help clinicians in the long-term management of patients.

Predictors of Functional Outcomes of Nonoperatively Treated Extra-articular Distal End Radius Fractures in Older Individuals: A Prospective Clinical Study.

Distal radius fractures (DRFs) are some of the most common injuries suffered by the elderly; however, there are varied opinions on management. As there is limited research on patient factors affecting functional outcomes in conservatively managed patients with DRFs, this study aimed to find predictive factors for functional outcomes in such patients. Patients with DRFs satisfying the inclusion criteria were managed with closed reduction and slab followed by cast application. Radiological parameters (radioulnar angulation, dorsal tilt, radial height, and ulnar variance) and functional scores (patient-rated wrist evaluation [PRWE] score, Short Form 8 questionnaire [SF-8], and QuickDASH [Disabilities of the Arm, Shoulder, and Hand]-9) were recorded prereduction, postreduction, at the time of cast removal, and in follow-up visits. Patient factors such as underlying diseases were also recorded, and correlations were analyzed using appropriate software. Patients with diabetes (43.33% of patients) and those with loss in radial height through the course of treatment were found to have poorer functional outcomes (P-values less than .05 for all functional scores-PRWE, QuickDASH-9, SF-8-except SF-8 at 12 weeks). Patients younger than 60 years were also found to have better functional outcomes at 24 weeks (for PRWE: P-value = .048, for QuickDASH-9: P-value = .032, and for SF-8: P-value = .026). Conservative management plays a major role in the treatment of DRFs, despite the increasing trend of operative management. Diabetes was found to be a predictor of poorer functional outcomes; however, further research is needed to determine the role of these and other factors in detail.