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Abstract Details

Days Alive and Out of Hospital as a Measure of Stroke Outcome in Patients Receiving Hyperacute Stroke Intervention
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (5:30 PM-6:30 PM)
6-009
Patient outcome after stroke is frequently assessed with the modified Rankin Scale score, which is a 7-level ordinal scale from 0 – no disability, to 6- dead that is usually obtained by in-person or telephone interviews. The mRS can be prone to bias and can have significant inter-rater variability.  Days alive and out of hospital at 90 days (DAOH-90) is an objective, readily available outcome measure that accounts for survival, time spent in hospital or rehabilitation settings, re-admission, and institutionalisation. 
To assess the criterion and construct validity of DAOH.

Consecutive ischemic stroke patients treated with thrombolysis or endovascular thrombectomy were used in this analysis. DAOH-90 was calculated from the national minimum dataset, an administrative nationwide database. mRS was assessed with in-person or telephone interviews. Simple descriptive statistics were applied (median [IQR]). The ability of DAOH-90 to distinguish between the commonly applied cut-points of mRS-90 was assessed using the area under the receiver operating curve (AUROC). Prognostic variables previously validated for mRS were assessed with Spearman’s correlation.

 

1278 ischemic stroke patients (714 male, median age 70[59-79], median NIHSS 14[9-20] were included in this study. Overall, median DAOH-90 was 71[29-84] and median mRS-90 was 3 [2-5]. There was a strong association between mRS-90 and DAOH-90 (spearman rho correlation 0.79, p<0.001). AUROC (95% CI) for predicting mRS > 0, mRS >1, mRS>2 were 0.86 (0.84-0.88), AUC 0.88 (0.86-0.90), AUC 0.90 (0.89-0.92) respectively. DAOH-90 was significantly correlated with age (spearman rho -0.13, p<0.001), admission NIHSS (spearman -0.44, p<0.001), Alberta stroke programme early CT score (spearman rho 0.24, p<0.001), and admission blood glucose concentration (spearman -0.24, p<0.001).

DAOH-90 is statistically valid outcome measure in ischemic stroke that strongly relates to mRS-90. DAOH is an objective, patient-centric outcome measure that can be determined from large datasets and therefore its place in stroke research warrants further study. 
Authors/Disclosures
Joseph Donnelly, MBChB
PRESENTER
Dr. Donnelly has nothing to disclose.
Jae Beom Hong, MBChB (Auckland City Hospital) Dr. Hong has nothing to disclose.
Luke Boyle, Other (University of Auckland) Mr. Boyle has nothing to disclose.
Vivien Yong, MBChB (Auckland District Health Board) Dr. Yong has nothing to disclose.
William Diprose, MBChB (Department of Neurology, Auckland City Hospital) Dr. Diprose has nothing to disclose.
Doug Campbell, MBBS The institution of Dr. Campbell has received research support from Neurological Foundation. The institution of Dr. Campbell has received research support from ANZCA. The institution of Dr. Campbell has received research support from Precision Driven Health.
Alan *use 047392 Barber, MBBS (Auckland Hospital) No disclosure on file