Scores outcome

Stneture SID CIO Active AID, AI0 7 AI0 9 AID 9 AIDJ.S AID 191 AIO l09 AID i0a AIO ll9 A Count Score Outeomel Score Oulcome. Score Outcome Score Outcome Score 0... 

Cost-benefit analysis Cost-effectiveness analysis Cost-consequences analysis Cost-utility analysis Cost-offset analysis Comprehensive Comprehensive Comprehensive Comprehensive Comprehensive Monetary valuation of outcomes One outcome only Multiple outcomes measured Summary utility score of outcomes No outcomes measured... 

Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000 355 1670-1674. 

The primary outcome of NINDS part I was early clinical improvement by 24 hours, dehned as complete resolution of the stroke symptoms or an improvement in the National Instimte of Health Stroke Scale (NIHSS) score by 4 or more points. There was no difference in early clinical improvement in the rt-PA group compared to the placebo group (relative risk 1.2, 95% Cl 0.9-1.6, p = 0.21). 

ECASS-II was designed to test a lower dose of rt-PA (0.9 mg/kg) during the same 0-6-hours time period after stroke onset, using similar inclusion criteria as in ECASS-I. ° The primary endpoint was the proportion with a favorable outcome on the mRS scale (defined as a score of 0 or 1). There was no difference in this outcome between rt-PA-treated and placebo controls (40% vs. 37%, p = 0.28). A separate analysis of the 158 subjects enrolled within 3 hours of stroke onset also showed no difference in the proportion with a favorable outcome (42% vs. 38%, p = 0.63) this result, however, must be treated with caution because in ECASS-II there was a substantially lower number of patients treated within 3 hours of stroke onset, compared to the 1995 NINDS rt-PA study. Parenchymal hematoma on post-treatment CT was seen in 12% of rt-PA-treated and 3% of placebo patients (p < 0.001). The 90-day mortality rate was 11 % for the rt-PA group and 11 % for the placebo group (p = 0.54). Protocol violations were much less frequent in ECASS-II compared to ECASS-I (9% vs. 18%), probably because of standardized training in CT interpretation at the study sites. 

A reversed bridging approach has been proposed by Keris et al. In this study, 12 patients (three ICA occlusions and nine MCA occlusions) out of the 45 enrolled (all with an NIHSS score >20) were randomized to receive an initial lA infusion of 25 mg of rt-PA over 5-10 minutes, followed by IV infusion of another 25 mg over 60 minutes, within 6 hours of stroke onset (total combined dose 50 mg with a maximum dose of 0.7 mg/kg). The remaining 33 patients were assigned to a control group and did not undergo any thrombolysis. TIMI 2 and 3 recanalization occurred in 1 of 12 and 5 of 12 of the patients, respectively. There were no symptomatic ICHs. At 12 months, 83% of the patients in the thrombolysis group were functionally independent, whereas only 33% of the control subjects had a good outcome. 

The ongoing IMS III trial is a randomized, multicenter, phase III trial continuing the investigation into the efficacy of the combined IV and lA approach to treat acute stroke. Patients are being randomized to IV/IA therapy and IV rt-PA alone in a 2 1 ratio. In the group allocated to combination IV/IA therapy, the physician will select either the EKOS microcatheter or a standard microcatheter to infuse rt-PA, or select the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) clot retrieval device. The primary outcome is the percentage of patients with an mRS score of 0-2 at 90 days. ... 

FIGURE 5.2 Clinical outcome of patients in the double-blind, proof-of-concept trial evaluating EPO in acute stroke, (a) Barthel Index (rhEPO vs. placebo, p < 0.05). (b) Modified Rankin Scale (rhEPO vs. placebo, p < 0.07) on day 30. Dead patients received the worst possible score. Evolution of lesion size of patients in the efficacy trial of Albumin in acute stroke, ((a-1) and DWI and (a-2) FLAIR.) (Reprinted with permission from reference 50.)... 

Specific predictive factors for outcome after surgical intervention have not been well defined in the literature. In one prospective, multicenter observational study of 95 patients, the state of consciousness was the only predictive factor retained in a logistic regression analysis." In this study, there was a 2.8-fold increased risk for poor outcome for each increase on a three-step scale (awake/drowsy, somnolent/ stuporous, and comatose), and good outcomes (modified Rankin Scale score <2) were achieved in 86%, 76%, and 47% of patients within each group, respectively. 

The Trial of Org 10172 in Acute Stroke Treatment (TOAST) was a randomized, double-blind, placebo-controlled trial of danaparoid in 1281 patients within 24 hours of onset of acute ischemic stroke. A three-stage dosage regime was used to achieve plasma anti-factor Xa activity of 0.8 unit/mL. Favorable outcome was defined as the combination of a Glasgow Outcome Scale (GOS) score of 1 or 2 and a modified Barthel Index (BI) score of 12 or greater (on a scale of 0-20) at 3 months or 7 days. Very favorable outcome required the combination of a GOS score of 1 and a Barthel Index (BI) score of 19 or 20 at 3 months or 7 days. 

Stroke patients who require mechanical ventilation are not necessarily destined for a poor outcome. In a study by Santoli et al., 58 patients underwent mechanical ventilation and 16 survived. Eleven achieved a Barthel Index (BI) score of 60, indicating a good outcome. Within this study population, those patients with bilaterally absent comeal and pupillary reflexes had uniformly poor outcomes, underscoring the need for careful assessment of brainstem reflexes in intubated stroke patients. Other factors that have been associated with poor outcome in intubated stroke patients are advanced age and lower Glasgow Coma Score (GCS) at the time of intubation, as well as seizures and pulmonary edema. ... 

The severity of the neurological deficit at the time of stroke onset is a major predictor of stroke outcome. In an analysis of the placebo-treated patients in the National Institute of Neurological Disorders and Stroke (NINDS) recombinant tissue-plasminogen activator (rt-PA) study, the best acute predictor of a poor outcome at 1 year was an National Institute of Health Stroke Scale (NIHSS) score >17 for patients over 70 years. These criteria had a high specificity (98%), but sensitivity was only 31%. The low sensitivity of the acute NIHSS score alone in predicting... 

Small vessel/lacunar strokes have better short- and long-term (1-year) survival as compared to other stroke subtypes. In the NINDS trial of rt-PA within 3 hours of onset, patients classified as small vessel stroke on the basis of their clinical syndrome had a 50% chance of a normal NIHSS score at 3 months if they received placebo, increasing to 70% in the treatment group. In the Lausanne cohort, 95% were independent after their first event, as opposed to only 65% of the cardioembolic strokes and 49% with large vessel atherothrombotic infarctions. Eighty-two percent of patients with small vessel stroke were independent at 1 year. Even at the time of maximal deficit, between 38% and 64% of small vessel/lacunar patients were independent, with motor impairment and extent of white matter disease adversely affecting outcomes. " In TOAST, small vessel/lacunar stroke was the only subtype associated with a favorable outcome, independent of the NIHSS score. ... 

Because the severity of the vascular lesion contributes to the size of the infarction and thus the clinical outcome, CTA results may be expected to predict outcome. One study assessed the utihty of CTA in 40 patients with acute stroke syndromes and an NIHSS score of >8. The extent of leptomeningeal collaterals on CTA correlated with the outcome from thrombolysis. In 40 hyperacute stroke patients who received rt-PA, those with CTA evidence of poor collaterals, autolysed thrombi, and T lesions showed little benefit from treatment. ... 

All clinical trials should have a pre-specified research question, which may be stated in the form of a primary hypothesis (or possibly a few primary hypotheses). An objective outcome measure or measures should also be clearly identified, such as the results of a biochemical test or the score on a validated scale. This allows statistical tests to be applied in order to assess the likelihood that any differences in response between treatment groups resulted from the active treatment and were not due to chance. 

Chasnoff et al. (1984) have reported on the developmental outcome of three groups of children, from birth until 2 years of age. The methadone, polydrug, and control groups demonstrated a downward trend in scores in the Bayley Scales of Infant Development. Their interpretation is that the infants environment and subsequent lack of stimulation has a more direct influence on long-term development than does maternal use of drugs during pregnancy. 

Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilator-associated pneumonia Prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003 31 676-682. 

The outcome from intraabdominal infection is not determined solely by what transpires in the abdomen. Unsatisfactory outcomes in patients with intraabdominal infections may result from complications that arise in other organ systems. A complication commonly associated with mortality after intraabdominal infection is pneumonia.26 A high APACHE (Acute Physiology And Chronic Health Evaluation) II score, a low serum albumin, and a high New York Heart Association cardiac function status were significantly and independently associated with increased mortality from intraabdominal infection.27... 

There are various severity of illness scoring systems for sepsis and trauma (R11). Severity scoring can be used, in conjunction with other risk factors, to anticipate and evaluate outcomes, such as hospital mortality rate. The most widely used system is the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) classification system (K12). The APACHE III was developed to more accurately predict hospital mortality for critically ill hospitalized adults (K13). It provides objective probability estimates for critically ill hospitalized patients treated in intensive care units (ICUs). For critically ill posttrauma patients with sepsis or SIRS, another system for physiologic quantitative classification and severity stratification of the host defense response was described recently (R11). However, this Physiologic State Severity Classification (PSSC) has yet not been applied routinely in ICU setting. 

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