Journal article
Association of admission clinical predictors and functional outcome in patients with Cerebral Venous and Dural Sinus Thrombosis
Clinical neurology and neurosurgery, Vol.188, pp.105563-105563
01/01/2020
DOI: 10.1016/j.clineuro.2019.105563
PMID: 31783304
Abstract
Objectives: Cerebral venous sinus thrombosis (CVST) is a rare subtype of stroke that most commonly affects younger women. While most patients treated with anticoagulation therapy have good outcomes, a significant number go on to experience disability. The primary aim of this study was to identify objective, easily reproducible, clinical admission predictors of poor outcome at discharge in patients with CVST.
Patients and methods: This was a retrospective cohort study of adult CVST patients admitted at our comprehensive stroke center between April 2004 and December 2017. The medical records of patients with a CVST discharge diagnosis code were reviewed for diagnosis confirmation and extraction of clinical and demographic admission data. Multivariable logistic regression was used to build predictive models of objective, standardized examination signs and adjusted for confounders. The primary endpoint was modified Rankin Scale score at discharge defined as good outcome (0-2) and poor outcome (3-6). Mortality was the secondary endpoint.
Results: A total of 176 CVST patients were identified. Most patients were white (91 %) and female (65 %). The median age was 40 years old. Headache was the most commonly reported symptom (74 %). Intracranial hemorrhage (ICH) was present in 27 % of patients, venous infarct occurred in 22 % of the patients, and 12 % had both. Age (OR = 1.03, 95 % CI 1.01-1.05), abnormal level of consciousness (OR = 4.38, 95 % CI 1.86-8.88), and focal motor deficits (OR = 3.49, 95 % CI 1.49-8.15) were found to be predictive of poor functional outcome. Pre-hospitalization infections (OR = 5.22, 95 % CI 1.51-18.07) and abnormal level of consciousness (OR = 9.22, 95 % CI 2.34-36.40) were significant predictors of mortality. The predictive effect remained significant after adjusting by median PTT level, presence of intracranial hemorrhage, and venous infarct.
Conclusions: Age, abnormal level of consciousness, and focal motor deficits identified at admission are independently associated with poor outcome in CVST patients. These frequently prevalent, easily reproducible examination signs represent the first step to develop a clinical prediction tool toward stratifying CVST patients with poor prognosis at admission.
Details
- Title: Subtitle
- Association of admission clinical predictors and functional outcome in patients with Cerebral Venous and Dural Sinus Thrombosis
- Creators
- Santiago Ortega-Gutierrez - University of Iowa Hospitals and ClinicsAndrea Holcombe - University of IowaNazan Aksan - University of Iowa Hospitals and ClinicsBiyue Dai - University of IowaAmir Shaban - University of IowaLara Lazarre - University of Iowa Hospitals and ClinicsBinbin Zheng-Lin - University of Iowa Hospitals and ClinicsLauren Sager - University of IowaSudeepta Dandapat - Univ Iowa Hosp & Clin, Dept Neurol, 2007 Roy J Carver Pavilion,200 Hawkins Dr, Iowa City, IA 52242 USAFazeel M. Siddiqui - Southern Illinois University School of MedicineNicholas M. Mohr - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.188, pp.105563-105563
- DOI
- 10.1016/j.clineuro.2019.105563
- PMID
- 31783304
- NLM abbreviation
- Clin Neurol Neurosurg
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Publisher
- Elsevier
- Number of pages
- 6
- Grant note
- Society of Vascular and Interventional Neurology 2018 SVIN Pilot research Grant award
- Language
- English
- Date published
- 01/01/2020
- Academic Unit
- Neurology; Radiology; Epidemiology; Emergency Medicine; Iowa Neuroscience Institute; Anesthesia; Injury Prevention Research Center; Neurosurgery; Internal Medicine
- Record Identifier
- 9984295924802771
Metrics
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