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    Home Time Is Extended in Patients With Ischemic Stroke Who Receive Thrombolytic Therapy A Validation Study of Home Time as an Outcome Measure

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    Author
    Mishra, NK; Shuaib, A; Lyden, P; Diener, H-C; Grotta, J; Davis, S; Davalos, A; Ashwood, T; Wasiewski, W; Lees, KR
    Date
    2011-04-01
    Source Title
    STROKE
    Publisher
    LIPPINCOTT WILLIAMS & WILKINS
    University of Melbourne Author/s
    Davis, Stephen
    Affiliation
    Medicine - Royal Melbourne Hospital
    Metadata
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    Document Type
    Journal Article
    Citations
    Mishra, N. K., Shuaib, A., Lyden, P., Diener, H. -C., Grotta, J., Davis, S., Davalos, A., Ashwood, T., Wasiewski, W. & Lees, K. R. (2011). Home Time Is Extended in Patients With Ischemic Stroke Who Receive Thrombolytic Therapy A Validation Study of Home Time as an Outcome Measure. STROKE, 42 (4), pp.1046-1050. https://doi.org/10.1161/STROKEAHA.110.601302.
    Access Status
    This item is currently not available from this repository
    URI
    http://hdl.handle.net/11343/28973
    DOI
    10.1161/STROKEAHA.110.601302
    Description

    C1 - Journal Articles Refereed

    Abstract
    BACKGROUND AND PURPOSE: "Home time" (HT) refers to the number of days over the first 90 after stroke onset that a patient spends residing in their own home or a relative's home versus any institutional care. It is an accessible and objective parameter, free from subjective bias, with potential as an outcome measure in acute stroke trials. We sought to validate HT and assess treatment responsiveness using independent data. METHODS: We estimated HT in the Stroke Acute Ischemic NXY Treatment (SAINT) I neuroprotection trial. We compared outcomes between thrombolyzed (T) and nonthrombolyzed comparators (C) using HT and the modified Rankin Scale. For our primary analysis, we adjusted for baseline covariates that significantly influence HT and in sensitivity analyses considered all variables that differed between groups at baseline. We report ordinal logistic regression and analysis of covariance with 95% CIs. We describe the relationship of HT with baseline National Institutes of Health Stroke Scale and its components and with Day 90 modified Rankin Scale and Barthel Index. RESULTS: SAINT I included 1699 patients from 23 countries, of whom 28.7% received alteplase. HT correlated with age, baseline severity, alteplase use, side of ischemic lesion, presence of diabetes, and country of patient enrollment (each P<0.05). We found an association between use of alteplase with better adjusted outcomes by either measure (OR for extended HT, 1.36; 95% CI, 1.08 to 1.72; P=0.009; analysis of covariance P=0.007 with a 5.5-day advantage; OR for more favorable modified Rankin Scale, 1.6; 95% CI, 1.28 to 2.00; P<0.0001; Cochran-Mantel-Haenszel P=0.046). HT was significantly associated with baseline National Institutes of Health Stroke Scale and each component of the National Institutes of Health Stroke Scale except level of consciousness, dysarthria, and ataxia. HT was significantly associated with Day 90 modified Rankin Scale and Barthel Index. CONCLUSIONS: HT is a responsive measure for use in multinational acute stroke trials. Its inclusion as a complementary outcome is reasonable. We propose treatment effects are adjusted for age, baseline National Institutes of Health Stroke Scale, side of stroke lesion, country of enrollment, and the presence of diabetes.
    Keywords
    Neurology and Neuromuscular Diseases; Nervous System and Disorders

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