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Related Experiment Videos

Progressing stroke: towards an internationally agreed definition.

Philip Birschel1, John Ellul, David Barer

  • 1Stroke Research Unit, Queen Elizabeth Hospital, Gateshead, UK.

Cerebrovascular Diseases (Basel, Switzerland)
|January 14, 2004
PubMed
Summary

Standardized definitions for early stroke deterioration and progression were developed and validated. These new definitions accurately predict poor outcomes in acute stroke patients, improving future research standards.

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Area of Science:

  • Neurology
  • Clinical Research
  • Stroke Medicine

Background:

  • Lack of standardized terminology and assessment procedures hinders the study of early neurological deterioration (progression) in acute stroke.
  • An international panel was convened to establish robust operational definitions for future studies.
  • Definitions were validated in an observational study across 10 European Stroke Database Collaboration centers.

Purpose of the Study:

  • To establish standardized operational definitions for early neurological deterioration (EDE) and stroke progression (SP) in acute stroke.
  • To validate these definitions in a multi-center observational study.
  • To assess the prognostic validity of the developed definitions for predicting poor outcomes.

Main Methods:

  • Standardized neurological assessments using the Scandinavian Stroke Scale (SSS) were performed daily for the first 3 days on acute stroke patients.

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  • EDE was defined as ≥2 SSS-point worsening (or ≥3 for speech score) between consecutive assessments.
  • SP was defined as neurological worsening by day 3 compared to baseline, or death within 72 hours.

    • Main Results:

    • Early deterioration episodes (EDEs) occurred in 33% and stroke progression (SP) in 26% of 563 cases.
    • Both EDEs and SP were identified as strong independent predictors of poor outcome.
    • The European Progressing Stroke Study (EPSS) definition of SP demonstrated superior prognostic efficiency compared to alternative definitions.

    Conclusions:

    • The EPSS definitions for EDEs and SP possess good construct and prognostic validity.
    • These definitions can be recommended as a standard for future research on the etiology and mechanisms of stroke progression.
    • Standardization enhances the reliability and comparability of studies investigating neurological deterioration in acute stroke.