BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.
- Publikační typ
- časopisecké články MeSH
Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-based stroke neurologists are mandated in the Czech Republic as triage and prenotification tool in acute stroke patients. The main aim of this study was to analyze the efficacy as well as quality of such teleconsultations in daily clinical practice. Methods: This is a descriptive analysis of teleconsultations between EMS paramedic crews and hospital-based neurologists in a geographically defined region of the Czech Republic (Moravian-Silesian region) between October 2018 to December 2018. All teleconsultations were analyzed for length and content. Content analysis included the following information: date, age, sex, prehospital neurological deficit(s), known/unknown time of symptom onset, anticoagulation status, vital signs, premorbid disability, and patient ID/insurance company number. Results: Within the study period, paramedics conducted 522 calls across 6 stroke centers. Of these, 334 (64%) calls were conducted because patients met pre-established prehospital criteria for suspected acute stroke. Median call duration was 1 min 44 s ± 56 s (minimum 50 s, maximum 5 min 5 s). Amongst the analyzed prehospital teleconsultations, stroke onset time was reported in 95% of cases, neurological deficit in 96%, significant co-morbidities in 53%, premorbid disability in 37%, and anticoagulation status in 53%. Conclusion: Teleconsultations between paramedics and hospital-based neurologists are not time-consuming. Stroke onset time and severity of neurological deficit are consistently communicated, however other important information such as comorbidities, premorbid disability, and anticoagulation status are reported inconsistently.
- Publikační typ
- časopisecké články MeSH
Background and Purpose: Ischemic stroke is a leading cause of mortality and morbidity worldwide. The time from stroke onset to treatment impacts clinical outcome. Here, we examined whether changing a triage model from "drip and ship" to "mothership" yielded significant reductions of onset-to-groin time (OGT) in patients receiving EVT and onset-to-needle time (ONT) in IVT-treated patients, compared to before FAST-PLUS test implementation. We also investigated whether the new triage improved clinical outcomes. Methods: In a before/after multicenter study, we evaluated the effects of changing the prehospital triage system for suspected stroke patients in the Moravian-Silesian region, Czech Republic. In the new system, the validated FAST PLUS test is used to differentiate patients with suspected large vessel occlusion and triage-positive patients are transported directly to the CSC. Time metrics and patient data were obtained from the regional EMS database and SITS database. Results: For EVT patients, the median OGT was 213 min in 2015 and 142 min in 2018, and the median TT was 142 min in 2015 and 47 min in 2018. For tPA patients, the median ONT was 110 min in 2015 and 109 min in 2018, and the median TT was 41 min in 2015 and 48 min in 2018. Clinical outcome did not significantly change. The percentages of patients with favorable clinical outcome (mRS 0-2) were comparable between 2015 and 2018: 60 vs. 59% in tPA patients and 40 vs. 44% in EVT patients. Conclusions: The new prehospital triage has yielded shorter OGTs for EVT patients. No changes were found in the onset-to-needle time for IVT-treated patients, or in the clinical outcome at 3 months after stroke onset.
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND PURPOSE: Manual segmentation of infarct volume on follow-up MRI diffusion-weighted imaging (MRI-DWI) is considered the gold standard but is prone to rater variability. We assess the variability of manual segmentations of MRI-DWI infarct volume. METHODS: Consecutive patients (May 2018 to May 2019) with the anterior circulation stroke and endovascularly treated were enrolled. All patients underwent 24- to 32-hour follow-up MRI. Three users manually segmented DWI infarct volumes slice by slice twice. The reference standard of DWI infarct volume was generated by the STAPLE algorithm. Intra- and interrater reliability was evaluated using the intraclass correlation coefficient (ICC) by comparing manual segmentations with the reference standard. Spatial measurements were evaluated using metrics of the Dice similarity coefficient (DSC). Volumetric measurements were compared using the lesion volume. RESULTS: The dataset consisted of 44 patients, mean (SD) age was 70.1 years (±10.3), 43% were women, and median baseline NIHSS score was 16. Among three users, the mean DSC for MRI-DWI infarct volume segmentations ranged from 80.6% ± 11.7% to 88.6% ± 7.5%, and the mean absolute volume difference was 2.8 ± 6.8 to 13.0 ± 14.0 ml. Interrater ICC among the users for DSC and infarct volume was .86 (95% confidence interval [95% CI]: .78-.91) and .997 (95% CI: .995-.998). Intrarater ICC for the three users was .83 (95% CI: .69-.93), .84 (95% CI: .72-.91), and .80 (95% CI: .64-.89) for DSC, and .99 (95% CI: .987-.996), .991 (95% CI: .983-.995), and .996 (95% CI: .993-.998) for infarct volume. CONCLUSIONS: Manual segmentation of infarct volume on follow-up MRI-DWI shows excellent agreement and good spatial overlap with the reference standard, suggesting its usefulness for measuring infarct volume on 24- to 32-hour MRI-DWI.
- MeSH
- algoritmy MeSH
- difuzní magnetická rezonance metody MeSH
- endovaskulární výkony metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozkový infarkt diagnostické zobrazování patologie terapie MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cévní mozková příhoda patří mezi nejčastější příčiny úmrtí nebo invalidizace a jedním z faktorů, který rozhoduje o výsledném klinickém stavu pacienta, je dostupnost včasné terapeutické intervence. Toto lze zajistit správnou přednemocniční triáží ve spolupráci s jednotkami zdravotnické záchranné služby. Cílem je pacienta s CMP rychle diagnostikovat a následně směřovat do nejbližšího iktového centra, případně při podezření na uzávěr velké mozkové tepny (LVO) indikovat převoz do centra s možností provedení mechanické trombektomie (MT). K tomu mohou posloužit různé přednemocniční testy. V Moravskoslezském kraji byl v roce 2016 zaveden FAST PLUS test hodnotící přítomnost těžké jednostranné hemiparézy, který předpovídá LVO se senzitivitou 92 % a specificitou 44 %. Je potřeba další výzkum v této oblasti ke zlepšování specificity testů bez zvýšení obtížnosti provedení testu.
Ischemic stroke is one of the leading causes of mortality or morbidity in the world. Early therapeutic intervention is important for final clinical outcome and that can be obtained by quick and correct prehospital triage, which is managed by paramedics. The patient with a stroke must by quickly diagnosed and transported to the nearest stroke center, or when a large vessel occlusion is suspected to the comprehensive stroke center to a possible thrombectomy. This decision can be made with different prehospital triage tests. "FAST PLUS" test was introduced in Moravian-Silesian region in year 2016 and it is focused on presence of a severe hemiparesis. The test predicts large vessel occlusion with 92 % sensitivity and 44 % specificity. More studies are needed to improve the specificity of prehospital tests without increasing their difficulty.
PURPOSE: Ischemic lesion volume (ILV) is an important radiological predictor of functional outcome in patients with anterior circulation stroke. Our aim was to assess the agreement between automated ILV measurements on NCCT using the Brainomix software and manual ILV measurements on diffusion-weighted imaging (DWI). METHODS: This was a prospective single-center observational study of patients with CT angiography (CTA) proven anterior circulation occlusion treated with endovascular thrombectomy (May 2018 to May 2019). NCCT ILV was measured automatically by the Brainomix software. DWI ILV was measured manually. The McNemar's test was used to test sensitivity and specificity. The Somer's delta was used to test the differences between concordant and discordant ASPECTS regions. The Bland-Altman plot was calculated to compare the differences between Brainomix and DWI ILVs. RESULTS: Forty-five patients were included. Median Brainomix ILV was 23 ml (interquartile range [IQR], 15-39 ml), and median DWI ILV was 11.5 ml (IQR, 7-32 ml) in the TICI 2b-3 group. In the TICI 0-2a, the NCCT ILV was 39 ml (IQR, 18-62 ml) and DWI ILV was 30 (IQR, 11-105 ml). The DWI ILVs in patients with good clinical outcome (mRS 0-2) was significantly lower compared with patients with mRS ≥ 3 (10 mL vs 59 mL, p = 0.002). Similar trend was observed for Brainomix ILV measurements (21 mL vs 39 mL, p = 0.012). There was a high correlation and accuracy in the detection of follow-up ischemic changes in particular ASPECTS regions. CONCLUSION: NCCT ILV measured automatically by the Brainomix software might be considered a valuable radiological outcome measure.
- MeSH
- CT angiografie metody MeSH
- difuzní magnetická rezonance MeSH
- ischemická cévní mozková příhoda diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- mozková angiografie metody MeSH
- prospektivní studie MeSH
- rentgenový obraz - interpretace počítačová metody MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- software MeSH
- strojové učení * MeSH
- trombektomie * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Cíl: Třídění pacientů záchranáři v přednemocniční péči by mohlo určit, kteří pacienti budou přímo transportováni do komplexního cerebrovaskulárního centra k provedení mechanické trombektomie. Aby třídění bylo úspěšné, zdravotničtí záchranáři musí být schopni identifikovat závažné neurologické postižení. Cílem naší studie bylo stanovit míru shody inter-rater reability mezi záchranáři a neurology - specialisty na CMP, při identifikaci těžké hemiparézy u pacientů s akutní CMP. Metodika: V prospektivní multicentrické studii bylo využito elektronické formy výuky u 225 záchranářů Zdravotnické záchranné služby tak, aby byli schopni rozlišit lehkou a těžkou hemiparézu. Ke stanovení míry shody mezi záchranáři a neurology - specialisty na CMP v hodnocení stupně závažnosti hemiparézy (National Institutes of Health Stroke Scale [NIHSS], body 5 a 6, skóre 0-2 [žádná nebo lehká] vs. 3-4 [těžká]) byl využit nevázaný index kappa;. Výsledky: Během 10 měsíců v roce 2016 bylo v přednemocniční neodkladné péči zdravotnickými záchranáři vyšetřeno na přítomnost hemiparézy 402 pacientů (průměrný věk 75 let), kteří byli současně ihned po přijetí do iktového centra vyšetřeni také neurology - specialisty na CMP. Celková shoda mezi záchranáři a neurology při hodnocení těžké hemiparézy nebo monoparézy byla mírná: kappa 0,43 (95% CI 0,36-0,50). Závěr: V hodnocení záchranářů v přednemocniční neodkladné péči byla zjištěna mírná reprodukovatelnost identifikace těžké hemiparézy u pacientů s akutní CMP. Před zavedením změn ve směrování na základě posouzení závažnosti neurologického deficitu je zapotřebí lepšího systému vzdělávání pro záchranáře.
Aim: Pre-hospital triage by paramedics could determine which patients qualify for direct transport to comprehensive stroke centres for mechanical thrombectomy. For triage to be successful, paramedics have to be able to identify major neurological impairments. The aim of our study was to determine inter-rater reliability between paramedics and stroke neurologists in identifying severe hemiparesis in acute stroke patients. Methods: In this prospective, multicentre study, 225 paramedics from Emergency Medical Services were taught via e-learning to distinguish between mild and severe hemiparesis. Inter-rater agreement between paramedics and stroke specialists in evaluating the degree of hemiparesis (National Institutes of Health Stroke Scale [NIHSS], items 5 and 6, scoring 0-2 [none or mild] vs. 3-4 [severe]) was assessed using the unweighted kappa; index. Results: Over the course of 10 months in 2016, 402 consecutive patients (average age 75 years) were evaluated for the presence of hemiparesis by paramedics during pre-hospital care and by stroke neurologists immediately after stroke centre admission. The total agreement between the paramedics and neurologists in their evaluations of severe hemiparesis or monoparesis was moderate: kappa; 0.43 (95% CI 0.36-0.50). Conclusion: We found moderate reproducibility of the identification of severe hemiparesis in acute stroke patients when assessed by paramedics in a pre-hospital setting. Better education for paramedics is needed before implementing a change in transport triage based on their assessment of severity of neurological deficit.
BACKGROUND: Neurofilaments are the major cytoskeletal components of neurons, and cell injury leads to their release into the surrounding area. The aim of this study was to compare the cerebrospinal fluid (CSF) and serum (S) concentrations of neurofilament light chains (NFLs) and phosphorylated neurofilament heavy chains (pNFHs). METHODS: Neurofilament concentrations were measured in CSF and S samples from 172 patients using three enzyme-linked immunosorbent assays. Excel, Stata version 13, MedCal version 17.9.7., and NCSS 2007 software were used for the statistical analysis. RESULTS: There was a statistically significant correlation between the concentrations of CSF NFL and CSF pNFH (rs = 0.748; n = 89; P < 0.001), but Passing-Bablok regression showed systematic deviation between the values obtained using the two assays. This indicates that the assays were not interchangeable. CSF pNFH and S pNFH concentrations showed low correlation. The kappa statistic showed moderate conformity between CSF pNFH and CSF NFL concentrations (κ = 0.556). CONCLUSIONS: The CSF NFL and CSF pNFH assays gave clinically consistent results that reflected the degree of axonal damage, independent of any particular neurological diagnosis. The S pNFH assays had a lower predictive value due to the low correlation coefficient and the kappa index of the CSF pNFH method.
- MeSH
- analýza rozptylu MeSH
- intermediární filamenta metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci nervového systému krev diagnóza metabolismus MeSH
- neurofilamentové proteiny krev mozkomíšní mok metabolismus MeSH
- regresní analýza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Cíl: Porovnání izoelektrické fokusace v agarosovém a polyakrylamidovém gelu pro detekci oligoklonálních pásů imunoglobulinu G (o-IgG) a oligoklonálních volných lehkých řetězců (oligoclonal free light chains; o-fLC). Soubor a metody: Detekce oligoklonálních pásů byla provedena v sérii 106 (o-IgG), resp. 48 (o-fLC) konsekutivních párových vzorků likvorů a sér. Pro srovnání obou metod a shody mezi hodnotícími byla použita statistika kappa. Výsledky: Při rozdělení nálezů na negativní a pozitivní byly rozdílně hodnoceny jen tři vzorky (2,8 %) pro o-IgG, tři vzorky (6,2 %) pro o-fLC kappa a jediný vzorek (2,1 %) pro o-fLC lambda. V těchto diskrepantních případech byl pozorován rozdíl nejvýše tří pásů. Shoda mezi hodnotícími pro o-fLC byla velmi dobrá (κ = 0,906-1,000). Závěry: Přestože polyakrylamidový gel může být teoreticky výhodnější vzhledem k menší velikosti pórů a lepšímu rozlišení, naše výsledky byly jak pro o-IgG, tak pro o-fLC velmi podobné jako při separaci v agarózovém gelu. Obě metody hodnotíme jako dobře použitelné a rozdíly mezi nimi byly omezeny na hraničně pozitivní případy.
Aim: To compare agarose and polyacrylamide isoelectric focusing for oligoclonal imunoglobulin G (o-IgG) and oligoclonal free light chains (o-fLC) detection. Patients and methods: Oligoclonal bands were detected in 106 (o-IgG) and 48 (o-fLC), resp. consecutive paired cerebrospinal fluid and serum samples. Kappa statistics was used for method comparison and inter-observer agreement. Results: When results were expressed as negative or positive, only three samples (2.8%) for o-IgG, three (6.2%) for o-fLC kappa and one (2.1%) for o-fLC lambda were evaluated differently. Maximum difference between methods was three bands in these discrepant cases. Inter-observer agreement for o-fLC was very good (κ = 0.906 - 1.000). Conclusions: Although polyacrylamide gel might be advantageous due to smaller pore size and hence better resolution, results for both o-IgG and o-fLC were very similar to agarose isoelectric focusing in our series. Both methods performed equally well and discrepances were restricted to borderline positive cases only.
- Klíčová slova
- volné lehké řetězce, izoelektrická fokusace, polyakrylamid, agaróza,
- MeSH
- biologické markery MeSH
- imunoglobulin G analýza MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- mozkomíšní mok MeSH
- oligoklonální proužky * analýza MeSH
- proteiny v mozkomíšním moku analýza imunologie MeSH
- Check Tag
- lidé MeSH
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is indicated for the treatment of large vessel occlusion (LVO) stroke. MT should be provided as quickly as possible; therefore, a test identifying suspected LVO in the prehospitalization stage is needed to ensure direct transport to a comprehensive stroke center (CSC). We assume that patients with clinically severe hemiparesis have a high probability of LVO stroke. We modified the FAST test into the FAST PLUS test: The first part is the FAST test and the second part evaluates the presence of severe arm or leg motor deficit. This prospective multicenter study evaluates the specificity and sensitivity of the FAST PLUS test in detecting LVO stroke. METHODS: Paramedics were trained through e-learning to conduct the FAST PLUS test. All prehospital suspected stroke patients who were administered the FAST PLUS test were included. Demographics, National Institutes of Health Stroke Scale (NIHSS) score, brain computed tomography (CT), and CT angiography (CTA) were recorded. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating curve (ROC) area for LVO were calculated. RESULTS: The study included 435 patients. LVO were found in 124 patients (28%). Sensitivity was 93%, specificity was 47%, PPV was 41%, NPV was 94%, and ROC area for ICA/MCA occlusion was 0.65. Intracerebral hemorrhage (ICH) was identified in 48 patients (11%). CONCLUSION: We found that the FAST PLUS test had a high sensitivity for LVO stroke. Of the 435 patients, 41% were all directly transported to a CSC based on positive FAST PLUS test scores and were potential candidates for MT.
- MeSH
- arteriální okluzní nemoci diagnóza etiologie patofyziologie MeSH
- bérec patofyziologie MeSH
- cévní mozková příhoda komplikace diagnóza patofyziologie MeSH
- CT angiografie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mozek diagnostické zobrazování patofyziologie MeSH
- obličej patofyziologie MeSH
- paréza diagnóza etiologie patofyziologie MeSH
- paže patofyziologie MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- urgentní zdravotnické služby metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
