Stroke: risk of deterioration varies between stroke subtypes

Clinical bottom line (level 4)

  1. One in four patients with a first-ever stroke deteriorated over the first 7 days.
  2. Patients with a TACI stroke were most likely to deteriorate, and patients with a PACI stroke least likely to deteriorate.
Tei et al: Stroke 2000; 31 : 2049-2054
Expires November 2003

The study

Prospective cohort study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospital, Japan

350 patients (aged 32 to 92; mean 67, 59% male) with a first-ever ischaemic stroke

Excluded if
  • cerebral haemorrhage

Patients were classified using teh Oxford Community Study Project stroke subtypes
  • total anterior circulation infarcts (TACI)
  • partial anterior circulation infarcts (PACI)
  • lacunar infarcts (LACI)
  • psterior circulation ninarcts (POCUI)


100% followed for 7 days
Outcomes studied:
  • deterioration
  • deterioration: TACI decrease by 1 point or more on Canadian Neurological Scale or Rankin Scale
  • deterioration: PACI
  • deterioration: LACI
  • deterioration: POCI

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    deterioration 7 days 90/350 26%
    (21% to 30%)    		 4
    (3 to 5)
    deterioration: TACI 7 days 36/86 42%
    (31% to 52%)    		 2
    (2 to 3)
    deterioration: PACI 7 days 4/63 6.3%
    (0.2% to 12.4%)    		 16
    (8 to 300)
    deterioration: LACI 7 days 37/141 26%
    (19% to 34%)    		 4
    (3 to 5)
    deterioration: POCI 7 days 13/60 22%
    (11% to 32%)    		 4
    (3 to 9)

    Citation

    1. Tei H, Uchiyama S, Ohara K, et al: deteriorating ischemic stroke in 4 clinical categories classified by the Oxfordshire Community Stroke Project. Stroke 2000; 31 : 2049-2054
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure stroke subtype
    Outcome clinical deterioration
    		•