Diagnostic accuracy of clinical stroke scores for distinguishing stroke subtypes: a systematic review
|
|
- Cynthia Long
- 6 years ago
- Views:
Transcription
1 Diagnostic accuracy of clinical stroke scores for distinguishing stroke subtypes: a systematic review Reviewers Clifford Mwita 1,2 MD Contact: cmwita@gmail.com Duncan Kajia 1 MBChB Contact: kajiahtree@yahoo.com Samson Gwer 1,3 MBChB, MRCPCH, PhD Contact: samgwer@gmail.com Anthony Etyang 4 MBChB, MMed Contact: aetyang@kilifi.kemri-wellcome.org Charles Newton 4,5,6 MBChB, MRCP, MD, FRCPCH Contact: cnewton@kilifi.kemri-wellcome.org 1. Joanna Briggs Institute Affiliate Center, Kenya 2. Thika Level-5 District Hospital, Thika, Kenya 3. Afya Research Africa, Nairobi, Kenya 4. Kenya Medical Research Institute (KEMRI)/ Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya 5. Neurosciences Unit, Institute of Child Health, University College London, United Kingdom 6. Department of Psychiatry, University of Oxford, Oxford, United Kingdom 1
2 Review question/objective This review aims to examine the sensitivity and specificity of clinical stroke scores in distinguishing ischemic and hemorrhagic stroke subtypes in patients with acute stroke and determine the score best suited for use in resource poor settings. The specific review question is: what is the sensitivity and specificity of clinical stroke scores in distinguishing ischemic from hemorrhagic stroke in patients with acute stroke, compared with non-contrast computed tomography? Background Stroke is a major cause of morbidity globally and is associated with up to 5.54 million deaths every year, two thirds of which occur in resource poor countries (RPC). 1 The prevalence of stroke is reported to be higher in developed countries, probably due to a higher proportion of elderly individuals in their population. However, it is possible that in resource poor settings, a lower prevalence is apparent due to higher case fatality. The World Health Organization (WHO) defines stroke as a clinical syndrome of rapid onset of focal cerebral deficit lasting more than 24 hours (unless interrupted by surgery or death) with no apparent cause other than a vascular one. There are two main subtypes, ischemic or hemorrhagic. Of the two types, ischemic stroke is more common, occurring in up to 80% of patients. 2 Infarction takes several hours to occur because following occlusion of a cerebral artery, anastomotic channels from other arterial territories open up to restore perfusion to its territory. This allows for restoration of blood supply and reversal of the process, with subsequent reduction in neurological deficits, disability and other complications. 2-3 Hemorrhagic stroke accounts for 15%-20% of all stroke cases and is associated with a higher mortality. 2, 4 There is bleeding directly into brain parenchyma due to damaged cerebral blood vessels. 5 Blood in the brain parenchyma causes disruption of neurons with localized cessation of function. The hemorrhage may expand and cause progression of neurological deficits. If large enough, it may cause a shift of intracranial contents and lead to rapid death. This type of stroke presents in a similar manner to ischemic stroke but has a more dramatic preceding clinical picture, usually headache, altered mental status, seizures, nausea and vomiting, and marked hypertension. However, none of these clinical features have been shown to reliably distinguish between the two sub-types of stroke. 6-7 Clinically, stroke may evolve from a transient ischemic attack (TIA), progressing stroke, to a completed stroke, based on the duration and evolution of symptoms. 3 In TIA, symptoms resolve within 24 hours of onset while in progressing stroke, symptoms worsen, perhaps due to increasing volume of infarct or haemorrhage. In a completed stroke, the neurological deficits persist but do not progress. Neurological deficits can be elicited from the history and, if persistent, from neurological examination. For optimal management of acute stroke, a distinction must be made between ischemic and hemorrhagic stroke since the therapy is different. 2 Ischemic stroke warrants institution of thrombolytic and/or antiplatelet therapy. Antiplatelet therapy has been shown to improve outcome and be cost effective even in RPC. 8-9 In the management of acute hemorrhagic stroke, haemostatic therapy may be given but there is conflicting evidence on its benefit. 5 Inadvertent administration of anti-platelet or anti-thrombotic therapy in hemorrhagic stroke sub-type may aggravate the clinical course. Conversely, use of haemostatic therapy in 2
3 ischemic stroke may promote vascular occlusion and worsen the infarction. Ideally, either thrombolytic or haemostatic therapy should be given soon after the onset of stroke in order to improve outcome. Index tests and reference test Non-contrast computed tomography (CT) scan is the most widely used brain imaging modality in patients with stroke and it reliably detects cerebral haemorrhage. It is the gold standard for distinguishing stroke sub-types It is cheaper than magnetic resonance imaging (MRI), but it is still expensive and inaccessible in many RPCs. To overcome the difficulties in accessing CT scan in the diagnosis of stroke and to enhance clinical bedside diagnosis, clinical stroke scores have been developed. The most commonly used ones include the Guy s hospital score (GHSS), 6 the Besson score, 12 the Greek stroke score 13 and the Siriraj stroke score (SSS). 14 In developing these scores, clinical variables that could potentially distinguish ischemia from haemorrhage in patients with acute stroke were used. A validation study was then performed to test the scores in patient populations other than the ones used in their development. The Greek score (GSS) was found to be 97% sensitive and 99% specific for the diagnosis of hemorrhagic stroke 13 while the Siriraj stroke score was 89.3% sensitive for haemorrhage and 93.2% sensitive for ischemia. 14 The Besson score had a positive predictive value of 100% in the diagnosis of ischemic stroke 12 while the Allen score is reported to have accurately diagnosed 90% of vascular lesions. 6 For the Siriraj score a score above 1 indicates hemorrhagic stroke while a score below -1 indicates ischemic stroke. A result between -1 and 1 indicates an equivocal result needing a CT scan. A score of below 4 for the Allen score indicates ischemic stroke while a score of above 24 indicates hemorrhagic stroke. For the Greek score, a score of 3 or less points to ischemic stroke while a score of 11 and above points to hemorrhagic stroke. A score of less than 1 for the Besson score diagnoses ischemic stroke with no cut off reported for hemorrhagic stroke. Rationale for the review CT scan is both expensive and largely unavailable in resource poor settings. There is also a paucity of specialists in the field of neurology with a large number of hospitals lacking a specialised stroke unit. Most patients with stroke in these parts of the world are inadequately diagnosed, resulting in poor outcomes. These constraints highlight the need for clinical stroke scores to distinguish between the stroke sub types. While these scores may not be sensitive enough to replace neuro-imaging, they are simple, cheap and practical, and do not require the presence of a specialist to administer and interpret. However, their true accuracy and value in the diagnosis of stroke remains unknown. We intend to conduct a systematic review of available literature to examine the evidence on the accuracy of clinical stroke scores in distinguishing between stroke sub types. Further, we aim to compare the accuracies of the clinical scores in order to determine which score is best suited for use in RPCs. Thus, this will be a review of diagnostic test accuracy. The main outcome measures will be sensitivity and specificity of the scores compared to CT scan as the reference standard. For the purpose of this review, sensitivity will be defined as the probability that a patient 3
4 with the disease will have a positive test result while specificity will be defined as the probability that a patient without the disease will have a negative test result. We searched PubMed, EMBASE, and the Cochrane and the Joanna Briggs Institute Libraries of systematic reviews in July 2012 and we did not identify any reviews either published or underway on this topic. Inclusion criteria Types of participants This review will consider patients admitted to hospital with a diagnosis of acute stroke according to the WHO criteria. 2 There will be no age or sex limitation and we will consider participants from all ethnic backgrounds. Types of interventions This review will consider studies that evaluate the Siriraj, Allen (Guy s Hospital), Besson and Greek stroke scores with CT-Scan as the reference standard. Details on the calculation of test scores have been described previously. 6, Studies that compare two or more of these scores simultaneously will also be included. Types of outcomes The review will consider studies that report on the sensitivity and specificity of stroke scores compared to CT scan diagnosis in distinguishing between stroke sub-types. Studies that do not report on sensitivity and specificity but have sufficient information to calculate these will also be considered for inclusion. Types of studies The review will consider studies of diagnostic test accuracy in which the index and reference tests are interpreted independently of one another on the same group of participants. Search strategy The search strategy aims to find both published and unpublished studies in English within the period A three step strategy will be implemented. First, we will conduct an initial search of PubMed and EMBASE with analysis of text words in the title and abstract and of index terms used to describe the article. A second search with all identified keywords and index terms across all included databases will then be done. Finally, the reference list of all included reports and articles will be searched for additional studies. Databases to be searched include: PubMed, EMBASE, Cochrane central register of controlled trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The search for unpublished studies will include: Virtual Health Library, System for Information for Grey Literature in Europe (SIGLE), Scientific Electronic Library Online (SciELO), MedNar and ProQuest. Initial keywords include: stroke, acute stroke, cerebrovascular accident, clinical stroke score, Siriraj stroke score, Guy s hospital stroke score, Allen score, Besson stroke score, Greek stroke score. 4
5 Assessment of methodological quality Papers selected for review will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the QUality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria 15 (Appendix I). Three other reviewers will randomly sample five or more included papers and assess them. Disagreements will be resolved through discussion. Data collection A modified Joanna Briggs Institute (JBI) data extraction form (Appendix II) will be used to collect details from included studies. Two authors will independently extract data from each study. Disagreements will be resolved through discussion. For each study, the following data will be obtained: author information, year of publication, study site, setting, study design, number and characteristics of patients (age, sex, ethnicity), reference standard, index test(s), information on clinicians who administered the scores and clinicians who interpreted the reference standard i.e. background specialty. Sensitivity and specificity, number of patients with equivocal scores, true positive (TP), false positive (FP), true negative (TN) and false negative (FN) data for each test will be taken directly from source papers. If this is not possible, they will be calculated from provided data. Extracted data with consensus from both authors will then be entered in a separate form and transferred to a spreadsheet. Data synthesis We aim to generate 2 X 2 contingency tables with true positive (TP), false positive (FP), true negative (TN) and false negative (FN) cases. We will consider patients with ischemic stroke as false positives or true negatives when analysing the performance for detecting hemorrhagic stroke and count patients with hemorrhagic stroke as false positives or true negatives when analysing performance for detection of ischemic stroke. We will calculate sensitivity and specificity with 95% confidence intervals for each clinical score for each study as well as predictive values and likelihood ratios. Meta-analysis will be undertaken using a bivariate mixed effects binomial regression model as described by Harbord et al. 16 Summary estimates for sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios (LR) as well as diagnostic odds ratio, will be generated. Where meta-analysis is not possible, a narrative synthesis will be undertaken. Heterogeneity will be assessed graphically using forest plots. For statistical heterogeneity we will use the quantity I 2 which describes the percentage of total variation across studies that is attributable to heterogeneity rather than chance. A value of 50% and above will be considered substantial heterogeneity. Analysis will be performed on STATA v.11 (Stata Corp, TX) using the midas 17 command and Review Manager Software version Conflicts of Interest None declared. 5
6 References 1. WHO. The world health report 2004-Changing history. The world health report 2004 (Statistical annex) WHO. Stroke. Neurological disorders: public health challenges Geneva: WHO Press; Boon NA, Colledge NR, Walker BR, Hunter JAA, editors. Davidson's Principles and Practice of Medicine. 20 ed. Philadelphia: Elsevier; Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation Oct 16;116(16):e Elliott J, Smith M. The acute management of intracerebral hemorrhage: a clinical review. Anesth Analg May 1;110(5): Allen CM. Clinical diagnosis of the acute stroke syndrome. Q J Med Autumn;52(208): von Arbin M, Britton M, de Faire U, Helmers C, Miah K, Murray V. Accuracy of bedside diagnosis in stroke. Stroke May-Jun;12(3): The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet May 31;349(9065): Heller RF, Langhorne P, James E. Improving stroke outcome: the benefits of increasing availability of technology. Bull World Health Organ. 2000;78(11): Sandercock P, Molyneux A, Warlow C. Value of computed tomography in patients with stroke: Oxfordshire Community Stroke Project. Br Med J (Clin Res Ed) Jan 19;290(6463): Wadhwani J, Hussain R, Raman PG. Nature of lesion in cerebrovascular stroke patients: clinical stroke score and computed tomography scan brain correlation. J Assoc Physicians India Jun;50: Besson G, Robert C, Hommel M, Perret J. Is it clinically possible to distinguish nonhemorrhagic infarct from hemorrhagic stroke? Stroke Jul;26(7): Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, et al. A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med Aug;252(2): Poungvarin N, Viriyavejakul A, Komontri C. Siriraj stroke score and validation study to distinguish supratentorial intracerebral haemorrhage from infarction. British Medical Journal. 1991;302(6792):
7 15. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol Nov 10;3: Harbord RM, Deeks JJ, Egger M, Whiting P, Sterne JA. A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics Apr;8(2): Dwamena BA. midas: A program for Meta-analytical Integration of Diagnostic Accuracy Studies in Stata. Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan RevMan 5 download and installation.[cited; Available from: org/revman/download. 7
8 Appendix I: Critical Appraisal Tool QUADAS TOOL 15 Item Yes No Unclear 1 Was the spectrum of patients representative of the patients who will receive the test in practice? 2 Were selection criteria clearly described? 3 Is the reference standard likely to correctly classify the target condition? 4 Is the time period between reference standard and index test short enough to be reasonably sure that the target condition did not change between the two tests? 5 Did the whole sample or a random selection of the sample, receive verification using a reference standard of diagnosis? 6 Did patients receive the same reference standard regardless of the index test result? 7 Was the reference standard independent of the index test (i.e. the index test did not form part of the reference standard)? 8 Was the execution of the index test described in sufficient detail to permit replication of the test? 9 Was the execution of the reference standard described in sufficient detail to permit its replication? 10 Were the index test results interpreted without knowledge of the results of the reference standard? 11 Were the reference standard results interpreted without knowledge of the results of the index test? 12 Were the same clinical data available when test results were interpreted as would be available when the test is used in practice? 13 Were uninterpretable/ intermediate test results reported? 14 Were withdrawals from the study explained? 8
9 APPENDIX II: DATA EXTRACTION FORM (Adapted from JBI MAStARI data extraction tool) Record Number Author Year Journal Study site Reviewer Setting Study design Participants (age, gender, ethnicity) Number of participants Index test (IT)1 Index test 2 Index test 3 Background of clinician(s) administering index test(s) Reference standard (RS) Background of clinician(s) interpreting reference standard Index test 1 Sensitivity(95%CI) Sensitivity(95%CI) Specificity(95%CI) Specificity(95%CI) Number with equivocal scores 9
10 Index text 2 Sensitivity(95%CI) Sensitivity(95%CI) Specificity(95%CI) Specificity(95%CI) Number with equivocal scores Index test 3 Sensitivity (95%CI) (95%CI) Specificity (95%CI) (95%CI) Sensitivity Specificity Number with equivocal scores k 10
JBI Database of Systematic Reviews & Implementation Reports 2014;12(2)
The effectiveness of reducing dietary sodium intake versus normal dietary sodium intake in patients with heart failure on reducing readmission rate: a systematic review protocol Palle Larsen 1,4 Preben
More informationSupplementary Online Content
Supplementary Online Content Wu HY, Peng YS, Chiang CK, et al. Diagnostic performance of random urine samples using albumin concentration vs ratio of albumin to creatinine for microalbuminuria screening
More informationIntroduction to diagnostic accuracy meta-analysis. Yemisi Takwoingi October 2015
Introduction to diagnostic accuracy meta-analysis Yemisi Takwoingi October 2015 Learning objectives To appreciate the concept underlying DTA meta-analytic approaches To know the Moses-Littenberg SROC method
More informationJournal Club. 1. Develop a PICO (Population, Intervention, Comparison, Outcome) question for this study
Journal Club Articles for Discussion Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group. N Engl J Med. 1995 Dec
More informationThe diagnosis of Chronic Pancreatitis
The diagnosis of Chronic Pancreatitis 1. Background The diagnosis of chronic pancreatitis (CP) is challenging. Chronic pancreatitis is a disease process consisting of: fibrosis of the pancreas (potentially
More informationTITLE: Appropriateness of CT Imaging to Support the Diagnosis of Stroke: A Review of the Clinical Evidence
TITLE: Appropriateness of CT Imaging to Support the Diagnosis of Stroke: A Review of the Clinical Evidence DATE: 22 November 2013 CONTEXT AND POLICY ISSUES In Canada, stroke is the third most common cause
More informationAppendix G: Methodology checklist: the QUADAS tool for studies of diagnostic test accuracy 1
Appendix G: Methodology checklist: the QUADAS tool for studies of diagnostic test accuracy 1 Study identification Including author, title, reference, year of publication Guideline topic: Checklist completed
More informationAntithrombotic therapy in patients with transient ischemic attack / stroke (acute phase <48h)
Antithrombotic therapy in patients with transient ischemic attack / stroke (acute phase
More informationMINDFULNESS-BASED INTERVENTIONS IN EPILEPSY
03 March 2016; v.1 MINDFULNESS-BASED INTERVENTIONS IN EPILEPSY AIM This review aimed to evaluate the effectiveness of mindfulness as a therapeutic intervention for people with epilepsy. METHODS Criteria
More informationEVIDENCE-BASED GUIDELINE DEVELOPMENT FOR DIAGNOSTIC QUESTIONS
EVIDENCE-BASED GUIDELINE DEVELOPMENT FOR DIAGNOSTIC QUESTIONS Emily Vella, Xiaomei Yao Cancer Care Ontario's Program in Evidence-Based Care, Department of Oncology, McMaster University, Ontario, Canada
More informationA comparison of treatment options for management of End Stage Kidney Disease in elderly patients: A systematic review protocol
A comparison of treatment options for management of End Stage Kidney Disease in elderly patients: A systematic review protocol Leanne Brown Master of Nursing Science (Nurse Practitioner) 1 Glenn Gardner
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Effectiveness of progressive muscle relaxation training for adults diagnosed with schizophrenia: a systematic review protocol Carlos Melo-Dias,
More informationThe detection and management of pain in patients with dementia in acute care settings: development of a decision tool: Research protocol.
The detection and management of pain in patients with dementia in acute care settings: development of a decision tool: Research protocol. Aims and Objectives of the overall study The aim of this study
More informationNQF ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form Collected For: The Joint Commission Only CMS Voluntary Only
Last Updated: Version 4.4a NQF ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Set: Stroke (STK) Set Measure ID #: Measure Information Form Collected For: The Joint Commission Only CMS
More informationChecklist for Diagnostic Test Accuracy Studies. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Diagnostic Test Accuracy Studies http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationCADTH Therapeutic Review
Canadian Agency for Drugs and Technologies in Health Agence canadienne des médicaments et des technologies de la santé CADTH Therapeutic Review August 2012 Volume 1, Issue 1A Antithrombotic Therapy for
More informationStroke 101. Maine Cardiovascular Health Summit. Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013
Stroke 101 Maine Cardiovascular Health Summit Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013 Stroke Statistics Definition of stroke Risk factors Warning signs Treatment
More informationCONCISE GUIDE National Clinical Guidelines for Stroke 2nd Edition
CONCISE GUIDE 2004 National for Stroke 2nd Edition This concise guide summarises the recommendations, graded according to the evidence, from the National 2nd edition. As critical aspects of care are not
More informationLothian Audit of the Treatment of Cerebral Haemorrhage (LATCH)
1. INTRODUCTION Stroke physicians, emergency department doctors, and neurologists are often unsure about which patients they should refer for neurosurgical intervention. Early neurosurgical evacuation
More informationOriginal Research Article
MAGNETIC RESONANCE IMAGING IN MIDDLE CEREBRAL ARTERY INFARCT AND ITS CORRELATION WITH FUNCTIONAL RECOVERY Neethu Tressa Jose 1, Rajan Padinharoot 2, Vadakooth Raman Rajendran 3, Geetha Panarkandy 4 1Junior
More informationOlder persons perceptions and experiences of community palliative care: a systematic review of qualitative evidence protocol
Older persons perceptions and experiences of community palliative care: a systematic review of qualitative evidence protocol Antoinette H. Cotton Jan Maree Sayers New South Wales Centre for Evidenced Based
More informationCanadian Best Practice Recommendations for Stroke Care. (Updated 2008) Section # 3 Section # 3 Hyperacute Stroke Management
Canadian Best Practice Recommendations for Stroke Care (Updated 2008) Section # 3 Section # 3 Hyperacute Stroke Management Reorganization of Recommendations 2008 2006 RECOMMENDATIONS: 2008 RECOMMENDATIONS:
More informationEffect of peak inspiratory pressure on the development. of postoperative pulmonary complications.
Effect of peak inspiratory pressure on the development of postoperative pulmonary complications in mechanically ventilated adult surgical patients: a systematic review protocol Chelsa Wamsley Donald Missel
More informationThis booklet has been published by CREST (the Clinical Resource Efficiency Support Team).
This booklet has been published by CREST (the Clinical Resource Efficiency Support Team). CREST is a small committee of health care professionals established under the auspices of the Central Medical Advisory
More informationEmergency Department Stroke Registry Process of Care Indicator Specifications (July 1, 2011 June 30, 2012 Dates of Service)
Specifications Description Methodology NIH Stroke Scale (NIHSS) Performed in Initial Evaluation used to assess the percentage of adult stroke patients who had the NIHSS performed during their initial evaluation
More informationGUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE
2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American
More informationThe objective of this systematic review is to assess the impact of migration on the risk of developing gastric cancer.
Review title The effect of migration on gastric cancer risk: A systematic review protocol Reviewers Haejin In, MD, MBA, MPH 1 Marisa Langdon-Embry, MS 2 1 Albert Einstein College of Medicine, haejin.in@einstein.yu.edu
More informationWorkshop: Cochrane Rehabilitation 05th May Trusted evidence. Informed decisions. Better health.
Workshop: Cochrane Rehabilitation 05th May 2018 Trusted evidence. Informed decisions. Better health. Disclosure I have no conflicts of interest with anything in this presentation How to read a systematic
More informationSetting The setting was secondary care. The study was carried out in the UK, with emphasis on Scottish data.
Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs Sandercock P, Berge E, Dennis M, Forbes J, Hand P, Kwan
More informationGuideline scope Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (update)
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Stroke and transient ischaemic attack in over s: diagnosis and initial management (update) 0 0 This will update the NICE on stroke and
More informationMeta-analysis of diagnostic research. Karen R Steingart, MD, MPH Chennai, 15 December Overview
Meta-analysis of diagnostic research Karen R Steingart, MD, MPH karenst@uw.edu Chennai, 15 December 2010 Overview Describe key steps in a systematic review/ meta-analysis of diagnostic test accuracy studies
More informationProtocol Sistematic Review
Master in Evidence-Based Practice e Metodologia della Ricerca Clinico-assistenziale Centro Studi EBN Azienda Ospedaliero - Universitaria di Bologna Policlinico S. Orsola - Malpighi Direttore del corso:
More informationBath, Philip M.W. and England, Timothy J. (2009) Thighlength compression stockings and DVT after stroke. Lancet. ISSN (In Press)
Bath, Philip M.W. and England, Timothy J. (2009) Thighlength compression stockings and DVT after stroke. Lancet. ISSN 0140-6736 (In Press) Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/1087/1/lancet_clots_1_20090522_4.pdf
More informationSmoking and Ischemic Stroke
Bangladesh Journal of Neuroscience 2008; Vol. 24 (1) : 50-54 Smoking and Ischemic Stroke MD JALAL UDDIN 1, BADRUL ALAM MONDOL 2, SHAHRUKH AHMED 3, AKM ANWAR ULLAH 4, MA JABBAR 5, QUAZI DEEN MOHAMMAD 6
More informationClopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis Schleinitz M D, Weiss J P, Owens D K
Clopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis Schleinitz M D, Weiss J P, Owens D K Record Status This is a critical abstract of an economic evaluation
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Efficiency
Quality ID #419: Overuse Of Neuroimaging For Patients With Primary Headache And A Normal Neurological Examination National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL
More informationASCEND Randomized placebo-controlled trial of aspirin 100 mg daily in 15,480 patients with diabetes and no baseline cardiovascular disease
ASCEND Randomized placebo-controlled trial of aspirin 100 mg daily in 15,480 patients with diabetes and no baseline cardiovascular disease Jane Armitage and Louise Bowman on behalf of the ASCEND Study
More informationStructural barriers to highly active antiretroviral therapy (HAART) adherence: a systematic review protocol
Structural barriers to highly active antiretroviral therapy (HAART) adherence: a systematic review protocol Garumma Tolu Feyissa MPH 1,5 Aderajew Nigussie MPH 2,5 Tariku Dejene Demissie MSc 3,5 Mirkuzie
More informationLuisa Vinciguerra. Ictus recidivanti
Luisa Vinciguerra Ictus recidivanti Recurrent Strokes DEFINITION Population-based studies exclude strokes: - within 28 or 21 days of the incident event - events in the same vascular territory as the original
More informationRedgrave JN, Coutts SB, Schulz UG et al. Systematic review of associations between the presence of acute ischemic lesions on
6. Imaging in TIA 6.1 What type of brain imaging should be used in suspected TIA? 6.2 Which patients with suspected TIA should be referred for urgent brain imaging? Evidence Tables IMAG1: After TIA/minor
More informationThe Effects of Macronutrient Intake on the Risk of Developing Type 2 Diabetes: A Systematic Review
Review Title The Effects of Macronutrient Intake on the Risk of Developing Type 2 Diabetes: A Systematic Review Centre Conducting Review The University of Newcastle Evidence Based Health Care Group: Joanna
More informationRestart or stop antithrombotics after intracerebral haemorrhage (ICH)?
Restart or stop antithrombotics after intracerebral haemorrhage (ICH)? Rustam Al-Shahi Salman professor of clinical neurology & honorary consultant neurologist www.rush.ed.ac.uk @BleedingStroke /bleedingstroke
More informationRisk factors for incident delirium in acute medical in-patients. A systematic review
Risk factors for incident delirium in acute medical in-patients. A systematic review Reviewers Emily Cull RN, BN(Hons) 1 Bridie Kent PhD, BSc(Hons), RN 2 Dr Nicole M. Phillips DipAppSc(Nsg), BN, GDipAdvNsg(Educ),
More informationVague Neurological Conditions
Vague Neurological Conditions Dr. John Lefebre, MD, FRCPC Chief Regional Medical Director Europe, India, South Africa, Middle East and Turkey Canada 2014 2 3 4 Agenda Dr. John Lefebre, M.D., FRCPC 1. TIA
More informationa. Ischemic stroke An acute focal infarction of the brain or retina (and does not include anterior ischemic optic neuropathy (AION)).
12.0 Outcomes 12.1 Definitions 12.1.1 Neurologic Outcome Events a. Ischemic stroke An acute focal infarction of the brain or retina (and does not include anterior ischemic optic neuropathy (AION)). Criteria:
More informationHealth Economics & Decision Science (HEDS) Discussion Paper Series
School of Health And Related Research Health Economics & Decision Science (HEDS) Discussion Paper Series Understanding the experience and impact of living with a vascular condition from the patients perspective:
More informationJBI Library of Systematic Reviews JBL ; 10 (58)
The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review protocol Jason T Slyer, DNP, RN, FNP-BC, CHFN 1,2 Lucille
More informationAppraising Diagnostic Test Studies
Appraising Diagnostic Test Studies Martin Bland Prof. of Health Statistics Dept. of Health Sciences University of York http://www-users.york.ac.uk/~mb55/msc/ Diagnostic Test Studies How well does a test
More informationFrom interventional cardiology to cardio-neurology. A new subspeciality
From interventional cardiology to cardio-neurology. A new subspeciality in the future? Prof. Andrejs Erglis, MD, PhD Pauls Stradins Clinical University Hospital University of Latvia Riga, LATVIA Disclosure
More informationSystematic reviews and meta-analyses of observational studies (MOOSE): Checklist.
Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist. MOOSE Checklist Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease:
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Percutaneous access for endovascular aortic aneurysm repair: a systematic review and meta-analysis Shahin Hajibandeh, Shahab Hajibandeh,
More informationCochrane Breast Cancer Group
Cochrane Breast Cancer Group Version and date: V3.2, September 2013 Intervention Cochrane Protocol checklist for authors This checklist is designed to help you (the authors) complete your Cochrane Protocol.
More informationThe effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review protocol
The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review protocol Megan Higgs, BN, MN, PhD Candidate 1,3 Ritin Fernandez, BSc (Nursing),
More informationImpact of asystematic review on subsequent clinical research
Impact of asystematic review on subsequent clinical research The case of the prevention of propofol injection pain Céline Habre 1,Martin R Tramèr 1,DanielM Pöpping 2, Nadia Elia 1,3 1 Division of Anaesthesiology,
More informationBritish Geriatrics Society
Healthcare professional group/clinical specialist statement Thank you for agreeing to give us a statement on your organisation s view of the technology and the way it should be used in the NHS. Healthcare
More informationThe SCAN rule: a clinical rule to reduce CT misdiagnosis of intracerebral haemorrhage in minor stroke
< See Editorial Commentary, p 239 1 University Department of Clinical Neurosciences, Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford, UK 2 Department of Neurology, Stoke Mandeville Hospital,
More informationSystematic Reviews and meta-analyses of Diagnostic Test Accuracy. Mariska Leeflang
Systematic Reviews and meta-analyses of Diagnostic Test Accuracy Mariska Leeflang m.m.leeflang@amc.uva.nl This presentation 1. Introduction: accuracy? 2. QUADAS-2 exercise 3. Meta-analysis of diagnostic
More information325 mg aspirin and plavix
325 mg aspirin and plavix 12-3-2006 Background Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for. Compare Aspirin
More informationParticipant views and experiences of participating in HIV research in sub-saharan Africa: a qualitative systematic review protocol
Participant views and experiences of participating in HIV research in sub-saharan Africa: a qualitative systematic review protocol Sylvia Nalubega, RN, BSc, MSc 1 Catrin Evans, RN, BSc, MA, PhD 1 1. The
More information: STROKE. other pertinent information such as recent trauma, illicit drug use, pertinent medical history or use of oral contraceptives.
INTRODUCTION A cerebral vascular accident (CVA) or stroke is a lack of blood supply to the brain as a result of either ischemia or hemorrhage. 80% of CVAs are a result of ischemia (embolic or thrombotic)
More informationStroke & the Emergency Department. Dr. Barry Moynihan, March 2 nd, 2012
Stroke & the Emergency Department Dr. Barry Moynihan, March 2 nd, 2012 Outline Primer Stroke anatomy & clinical syndromes Diagnosing stroke Anterior / Posterior Thrombolysis Haemorrhage The London model
More informationSUPERVISORS: PROF E. AMAYO, CONSULTANT NEUROLOGIST, ASSOCIATE PROFESSOR OF MEDICINE DEPT. OF CLINICAL MEDICINE AND THERAPEUTICS - UoN DR MECHA,CONSULT
30-DAY OUTCOME OF STROKE IN PATIENTS AT KENYATTA NATIONAL HOSPITAL. DR ANDREW KAMAU NDARA PHYSICIAN MBChB, Mmed 26/11/11 K.A.P MEETING K.I.C.C SUPERVISORS: PROF E. AMAYO, CONSULTANT NEUROLOGIST, ASSOCIATE
More informationEmergency Department Management of Acute Ischemic Stroke
Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,
More informationCEREBRO VASCULAR ACCIDENTS
CEREBRO VASCULAR S MICHAEL OPONG-KUSI, DO MBA MORTON CLINIC, TULSA, OK, USA 8/9/2012 1 Cerebrovascular Accident Third Leading cause of deaths (USA) 750,000 strokes in USA per year. 150,000 deaths in USA
More informationVALIDATION STUDY OF THE SIRIRAJ STROKE SCORE IN NORTH-EAST NIGERIA
Nigerian Journal of Clinical Practice Sept. 2008 Vol 11(3):176-180 VALIDATION STUDY OF THE SIRIRAJ STROKE SCORE IN NORTH-EAST NIGERIA YW Nyandaiti, SA Bwala Department of Medicine, University of Maiduguri
More informationJBI Database of Systematic Reviews & Implementation Reports 2013;11(9)
Effectiveness of surgical versus conservative treatment for symptomatic unilateral spondylolysis of the lumbar spine in athletes: a systematic review protocol Morné Scheepers 1 MBCHB, BHSC (physio) Manuel
More informationBACKGROUND AND SCIENTIFIC RATIONALE. Protocol Code: ISRCTN V 1.0 date 30 Jan 2012
BACKGROUND AND SCIENTIFIC RATIONALE Protocol Code: ISRCTN15088122 V 1.0 date 30 Jan 2012 Traumatic Brain Injury 10 million killed or hospitalised every year 90% in low and middle income countries Mostly
More informationSystematic Reviews of Studies Quantifying the Accuracy of Diagnostic Tests and Markers
Papers in Press. Published September 18, 2012 as doi:10.1373/clinchem.2012.182568 The latest version is at http://hwmaint.clinchem.org/cgi/doi/10.1373/clinchem.2012.182568 Clinical Chemistry 58:11 000
More informationAntithrombotics: Percent of patients with an ischemic stroke or TIA prescribed antithrombotic therapy at discharge. Corresponding
Get With The Guidelines -Stroke is the American Heart Association s collaborative performance improvement program, demonstrated to improve adherence to evidence-based care of patients hospitalized with
More informationManagement of new onset atrial fibrillation McNamara R L, Bass E B, Miller M R, Segal J B, Goodman S N, Kim N L, Robinson K A, Powe N R
Management of new onset atrial fibrillation McNamara R L, Bass E B, Miller M R, Segal J B, Goodman S N, Kim N L, Robinson K A, Powe N R Authors' objectives To synthesise the evidence that exists to guide
More informationThe effects of cognitive behaviour therapy for major depression in older adults
The effects of cognitive behaviour therapy for major depression in older adults Submitted by Rasika Sirilal Jayasekara RN, BA (Sri Lanka), BScN (Hons) (Sri Lanka), PG Dip Ed (Sri Lanka), MNSc (Adelaide),
More informationIt is the nature of a stroke to partly take away the use of a man s limbs and to throw him onto the parish if he had no children to look to
It is the nature of a stroke to partly take away the use of a man s limbs and to throw him onto the parish if he had no children to look to George Eliot The Cripples (1949) All cerebrovascular events in
More informationLONGITUDINAL EVALUATION OF COGNITION AFTER STROKE A SCOPING REVIEW
LONGITUDINAL EVALUATION OF COGNITION AFTER STROKE A SCOPING REVIEW Juan Pablo Saa Doctor of Occupational Therapy Master of Public Health Washington University in St. Louis. USA PhD Candidate La Trobe University,
More informationNURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS I. Purpose : A. To reduce morbidity and mortality associated
More informationAssessment of tumor response to chemotherapy in patients with breast cancer using 18 F-FLT: a meta-analysis
Original Article Assessment of tumor response to chemotherapy in patients with breast cancer using 18 F-FLT: a meta-analysis Sheng-Ming Deng 1,2,3, Wei Zhang 1, Bin Zhang 1,3, Yi-Wei Wu 1 1 Department
More informationAlan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with L numbness & slurred speech 2 episodes; 10 mins & 2 hrs Hypertension Type II DM Examination pulse 80/min reg, BP 160/95
More informationHEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM
REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,
More informationHorizon Scanning Technology Summary. Magnetic resonance angiography (MRA) imaging for the detection of coronary artery disease
Horizon Scanning Technology Summary National Horizon Scanning Centre Magnetic resonance angiography (MRA) imaging for the detection of coronary artery disease April 2007 This technology summary is based
More informationGATE CAT Diagnostic Test Accuracy Studies
GATE: a Graphic Approach To Evidence based practice updates from previous version in red Critically Appraised Topic (CAT): Applying the 5 steps of Evidence Based Practice Using evidence from Assessed by:
More informationStroke Update. Lacunar 19% Thromboembolic 6% SAH 13% ICH 13% Unknown 32% Hemorrhagic 26% Ischemic 71% Other 3% Cardioembolic 14%
Stroke Update Michel Torbey, MD, MPH, FAHA, FNCS Medical Director, Neurovascular Stroke Center Professor Department of Neurology and Neurosurgery The Ohio State University Wexner Medical Center Objectives
More informationRecombinant Factor VIIa for Intracerebral Hemorrhage
Recombinant Factor VIIa for Intracerebral Hemorrhage January 24, 2006 Justin Lee Pharmacy Resident University Health Network Outline 1. Introduction to patient case 2. Overview of intracerebral hemorrhage
More informationAntithrombotic management options for acute ischemic large-vessel stroke: A meta-analysis of randomized clinical trials
Antithrombotic management options for acute ischemic large-vessel stroke: A meta-analysis of randomized clinical trials Background Stroke affects one in every 20 individuals in developed countries and
More informationDisclosures. An Update on TIA and Minor Stroke. The Agenda PROGNOSIS PATHOPHYSIOLOGY GUIDELINES AND PROVEN MANAGEMENT STRATEGIES AGGRESSIVE TREATMENT
Disclosures An Update on TIA and Minor Stroke Dr. Johnston is principal investigator for the POINT trial, sponsored by the NIH but with drug and placebo contributed by Sanofi-Aventis. S. Claiborne Johnston,
More informationDrain versus no-drain after gastrectomy for patients with advanced gastric cancer Student EBM presentations
Drain versus no-drain after gastrectomy for patients with advanced gastric cancer Student EBM presentations Selali Fiamanya & Jawaad Farrukh University of Oxford October 2014 The question Mr X is a 56
More informationDATE: 25 March, Healthcare Hamilton, Ontario, Canada. University, Hamilton, Ontario, Canada
Comparative value of erythrocyte sedimentation rate () and C- reactive protein (CRP) testing in combination versus individually for the diagnosis of undifferentiated patients with suspected inflammatory
More informationHuangdao People's Hospital
Table of contents 1. Background... 3 2. Integrated care pathway implementation... 6 (1) Workload indicators... 6 A. In eligible for care pathway... 6 B. Care pathway implementation... 7 (2) Outcome indicators...
More informationPFO closure group total no. PFO closure group no. of males
Suppl Table. Characteristics of the five trials included in this meta-analysis. Trial name Device used for Definition of medical Primary Endpoint group total no. group no. of males group age (yrs) group
More informationMechanical thrombectomy in Plymouth. Will Adams. Will Adams
Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation
More informationDATE: 04 April 2012 CONTEXT AND POLICY ISSUES
TITLE: Procedure Site Bleeding Complications Following Percutaneous Coronary Interventions or Angioplasty: A Review of Clinical Evidence and Guidelines DATE: 04 April 2012 CONTEXT AND POLICY ISSUES Percutaneous
More informationMeta-analysis of diagnostic test accuracy studies with multiple & missing thresholds
Meta-analysis of diagnostic test accuracy studies with multiple & missing thresholds Richard D. Riley School of Health and Population Sciences, & School of Mathematics, University of Birmingham Collaborators:
More informationNicolas Bianchi M.D. May 15th, 2012
Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the
More informationMEDICAL POLICY EFFECTIVE DATE: 12/18/08 REVISED DATE: 12/17/09, 03/17/11, 05/19/11, 05/24/12, 05/23/13, 05/22/14
MEDICAL POLICY SUBJECT: CT (COMPUTED TOMOGRAPHY) PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationAdult women s experiences of urinary incontinence: a systematic review of qualitative evidence protocol
Adult women s experiences of urinary incontinence: a systematic review of qualitative evidence protocol Adilson Mendes 1 Luiza Hoga 1 Bruna Gonçalves 1 Pamela Silva 1 Priscilla Pereira 1 1. School of Nursing,
More informationBackground: Traditional rehabilitation after total joint replacement aims to improve the muscle strength of lower limbs,
REVIEWING THE EFFECTIVENESS OF BALANCE TRAINING BEFORE AND AFTER TOTAL KNEE AND TOTAL HIP REPLACEMENT: PROTOCOL FOR A SYSTEMATIC RE- VIEW AND META-ANALYSIS Background: Traditional rehabilitation after
More informationDatabase of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright 2017 University of York.
A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling Brown
More informationStroke Special Project 640 and 740 Resource For Health Information Management Professionals
Stroke Special Project 640 and 740 Resource For Health Information Management Professionals Linda Gould RPN Erin Kelleher, BA, CHIM Stefan Pagliuso PT, B.A. Kin(Hon.) Overview of this Resource Overview
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Mazzucco S, Li L, Binney L, Rothwell PM. Prevalence
More informationCurrent role of low molecular weight heparin in the treatment of acute. ischemic stroke.
International Journal of Advances in Medicine Singh K. Int J Adv Med. 2017 Dec;4(6):1599-1604 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20175174
More information