Pre-stroke Functional Status in Patients Undergoing Mechanical Thrombectomy: How Relevant Are False Estimations in the Emergency Setting?

Clinical Neuroradiology, vol. 35, pp. 17–23

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.

Authors 8

1. Marian Maximilian Hasl Aachen Department of Diagnostic and Interventional Neuroradiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany

2. João Pinho corresponding Aachen Department of Neurology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany. jferreiradep@ukaachen.de

   Department of Neurology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany

3. Sophie Gina Baldus Aachen Department of Diagnostic and Interventional Neuroradiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany

4. Anna Gerhards Aachen Department of Diagnostic and Interventional Neuroradiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany

5. Martin Wiesmann Aachen Department of Diagnostic and Interventional Neuroradiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany

6. Jörg Bernhard Schulz Aachen Department of Neurology JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11)

   Forschungszentrum Jülich · Universitätsklinikum Aachen · Jülich Aachen Research Alliance · RWTH Aachen University

   Affiliation as printed

   Department of Neurology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany

   Forschungszentrum Jülich GmbH and RWTH Aachen University, JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Aachen, Germany

7. Arno Reich Aachen Department of Neurology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany

8. Omid Nikoubashman Aachen Department of Diagnostic and Interventional Neuroradiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany