Stroke: a fifth of patients had early improvement.

Clinical bottom line (level 2c)

  1. A fifth of patients with acute ischaemic supratentorial stroke had neurological improvement within 30 days.
  2. 3% of patients with improving acute ischaemic stroke were dead at 30 days.
  3. A sixth of patients with stable acute ischaemic stroke were dead at 30 days.
  4. A third of patients with deteriorating acute ischaemic stroke were dead at 30 days.
Toni et al: Stroke 1997; 22: 10-14
Expires December 2002

The study

Inception cohort study with ?objective ?blinded outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: stroke unit, Italy

152 patients (aged mean 66 years, 55% male) admitted within 5 hours of the onset of first-ever acute ischaemic supratentorial stroke
Medical therapies for concomitant diseases was given, as were osmotics, antiplatelet agents, subcutaneous or intravenous heparin and oral anticoagulants (sometimes in combination), when indicated.

100% followed for 30 days
Outcomes studied:
  • early neurological improvement : increase in the global score (out of ten) evaluating level of consciousness, orientation, speech and facial and limb strength, of 1 or more points within the first 48 hours after stroke
  • mortality in improving patients
  • mortality in stable patients
  • mortality in deteriorating patients

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    early neurological improvement 30 days 34/152 22.4%
    (15.7% to 29.0%)
    mortality in improving patients 30 days 1/34 2.94%
    (0.01% to 15.3%)
    mortality in stable patients 30 days 14/84 16.7%
    (8.70% to 24.6%)
    mortality in deteriorating patients 30 days 13/34 38.2%
    (21.9% to 54.6%)

    • Younger age (p=<0.01), lower CNS score at entry (p=0.02) and absence of early hypodensity at first CT scan (p=0.01) were considered to be independent predictors of early improvement.

    Citation

    1. Toni D, Fiorelli M, Bastianello S, et al: Acute ischaemic strokes improving during the first 48 hours of onset: Predictability, outcome, and possible mechanism. Stroke 1997; 22: 10-14
    Contributor: Clare Wotton and Bob Phillips, December 1999
    Reviewer:

    Clinical Question.
    Patient acute ischaemic stroke
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome early neurological improvement