Journal article
Correlation between pre-admission blood pressure and outcome in a large telestroke cohort
Journal of clinical neuroscience, Vol.62, pp.33-37
04/2019
DOI: 10.1016/j.jocn.2019.01.014
PMID: 30660477
Abstract
•We didn’t observe any statistical association between SBP variation and long term clinical outcome.•We didn’t observe association between SBP during the acute phase and clinical outcome.•We advocate lowering SBP to <185 mmHg to increase IVrt-PA eligibility rates.•We recruited new stroke patients eligible for MT through the TS network.•38% of MT patients had an mRS ≤ 2 on their last follow-up visit.•Fulfilling new strategies and approaches to stroke patients leads to better results.
Telemedicine rapidly connects patients, with acute ischemic stroke symptoms, with neurovascular specialists for assessment to reduce chemical thrombolysis delivery times. Management of AIS includes maintaining target systolic blood pressures (SBP). In this retrospective study, we assess the efficacy of the telestroke (TS) system at a primary stroke center and the prognostic value of SBP throughout the transportation process.
Patients presenting with acute-onset neurological symptoms to the TS hospitals network, over a 5-year period, were assessed. Those with a confirmed diagnosis of AIS were included. We examined demographics, presenting-NIHSS, last SBP before transfer from the network hospital and continuous BP during transport, stroke risk factors, hospital-course, door-to-needle (DTN) time, treatments, and modified Rankin Scale(mRS). Multivariate analysis was conducted to evaluate the prognostic value of SBP on stroke outcome.
Of 2,928 patients identified, 1,353 were diagnosed with AIS. Mean age was 66.6 years (SD = 15.4), 47.6% female. Most cases affected the MCA(44.5%). Mean presenting-NIHSS was 8.67(SD = 8.38) and mean SBP was 148 mmHg(SD = 25.39). 73.2% treated using a standard protocol, 23.7% given IVrt-PA, and 6.8% received mechanical thrombectomy(MT). Mean DTN was 96 min(SD = 46; 27.3% <60 min). Age, presenting-NIHSS and pre-existing hypertension were associated with higher mortality and/or higher mRS. SBP was not associated with higher mortality and morbidity.
This study displays better clinical outcomes at latest follow-up when compared to current international TS studies. SBP during transportation to the hub hospital did not prove to be a useful prognostic metric. However, future studies should address the limitations of this study to confirm these findings.
Details
- Title: Subtitle
- Correlation between pre-admission blood pressure and outcome in a large telestroke cohort
- Creators
- Ahmad Sweid - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesElias Atallah - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesHassan Saad - Department of Neurological Surgery, Arkansas Neurosciences Institute, Little Rock, AR, United StatesKimon Bekelis - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesNohra Chalouhi - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesSophia Dang - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesJonathan Li - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesAyan Kumar - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesJustin Turpin - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesRanda Barsoom - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesStavropoula Tjoumakaris - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesDavid Hasan - Department of Neurological Surgery, University of Iowa, Department of Neurosurgery, Iowa City, IA, United StatesMaureen DePrince - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesGiuliana Labella - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesRobert H Rosenwasser - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United StatesPascal Jabbour - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
- Resource Type
- Journal article
- Publication Details
- Journal of clinical neuroscience, Vol.62, pp.33-37
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.jocn.2019.01.014
- PMID
- 30660477
- ISSN
- 0967-5868
- eISSN
- 1532-2653
- Language
- English
- Date published
- 04/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040378702771
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