AI Article Synopsis
- The modified Rankin scale (mRS) is used in emergency settings to gauge the functional status of stroke patients before treatment, and the study compares assessments made in the emergency department (ED) versus after hospital admission.
- A total of 409 ischemic stroke patients were examined, revealing that there was a significant agreement between the two assessments, yet 17% of patients showed an overestimation of their pre-stroke functional status in the ED.
- Overestimating functional status in the ED was linked to older age, increased prevalence of diabetes and past strokes, and negatively impacted the likelihood of achieving functional independence three months later.
Article Abstract
Purpose: The modified Rankin scale (mRS) is frequently used in the emergency setting to estimate pre-stroke functional status in stroke patients who are candidates to acute revascularization therapies (ps-mRS). We aimed to describe the agreement between pre-stroke mRS evaluated in the emergency department (ED-ps-mRS) and pre-stroke mRS evaluated comprehensively post-admission (PA-ps-mRS).
Methods: Retrospective study of consecutive ischemic stroke patients undergoing mechanical thrombectomy, with available ED-ps-mRS and PA-ps-mRS. ED-ps-mRS was evaluated by the treating neurologist and documented in the emergency stroke treatment protocol. PA-ps-mRS was retrospectively evaluated with information registered in the clinical record. Collection of baseline characteristics and 3‑month outcomes. Patients with ED-overestimated pre-stroke functional status (ED ps-mRS ≤ 2 and PA-ps-mRS ≥ 3) were compared to correct low and high ED-ps-mRS groups.
Results: We included 409 patients (median age 77 years, 50% female, median NIHSS 14). Concordance of dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) was found in 81.4% (Cohen's kappa = 0.476, p < 0.001). ED-overestimated pre-stroke functional status was found in 69 patients (17%). Patients with ED-overestimated pre-stroke functional status were older (p < 0.001), more frequently presented diabetes (p < 0.001), previous stroke (p = 0.014) and less frequently presented 3‑month functional independence (p < 0.001) compared to patients with correct low ED-ps-mRS. No differences in pre-stroke baseline characteristics between overestimated and correct high ED-ps-mRS was found.
Conclusion: Disagreement between dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) occurred in 1/5 of patients. Overestimation of pre-stroke functional status may falsely reduce the expected proportion of patients achieving favourable 3‑month functional outcomes.
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| http://dx.doi.org/10.1007/s00062-024-01449-5 | DOI Listing |
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