Pre-stroke functional status in patients undergoing mechanical thrombectomy: How relevant are false estimations in the emergency setting?

RWTH Publications (RWTH Aachen)

Abstract

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). 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. 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. 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 1

1. Marian Maximilian Hasl corresponding Aachen

   RWTH Aachen University

   Affiliation as printed

   RWTH Aachen