Abstract TP97: Feasibility and Reliability of Patient-Reported Scores to Assess Long-Term Functional Outcomes in Stroke: A Sub-Group Analysis of the MaRISS Trial

Abstract only Obtaining delayed functional outcomes such as the modified Ranking score (mRS) after stroke is challenging in clinical practice, often resulting in missing data. Self-reported outcomes are an alternative to functional outcome collection, but their reliability and accuracy are not well-established Methods: In this subgroup analysis of the Mild and Rapidly Improving Stroke Study (MaRISS), we aimed to test the feasibility and reliability of the MaRISS Patient Reported Outcome (PRO) survey tool for obtaining delayed functional outcomes in low (0-5) National Institute of Health Stroke Scale ischemic stroke, particularly the modified Rankin Score (mRS), by assessing its inter-rater reliability with a score calculated by a clinician through a structured telephone interview. Other scores were compared as secondary outcomes. 125 surveys were distributed between January 2017 and July 2018. The tool consisted of an online survey aiming to collect information regarding the patient's functional status 90 days after stroke including the mRS (utilizing the mRS 9-Q version), Stroke Impact Scale-16 (SIS), Barthel Index (BI), European Quality of Life-5D-5L (EQ-Index). All participants also completed these scales administered by trained personnel through a structured telephone interview. Cohen's weighted kappa coefficients (κ) with 95% confidence intervals (CI) were calculated to assess the reliability of the PRO Tool Results: Of 125 surveys sent, 55/125 (46.4%) participants opened and started the survey but only 44/125 (36.8%) completed it entirely (mean age 62±12.5, 54.6% female, white 79.6%, NIHSS 2.3±1.8, ischemic stroke 84%, 16% TIA). 52 subjects completed both the online mRS 9-Q PRO and the telephone version (Table). The weighted kappa for the comparison of PRO mRS and the clinician-performed mRS was moderate [κ 0.53, SE 0.10; 95% CI (0.3-0.7)] as well as for the SIS (κ 0.43, SE 0.09) and EQ-Index (κ 0.40, SE 0.10) scores, whereas for BI was fair (κ 0.32, SE 0.15) Discussion: Engaging participants after hospital discharge remains difficult. Although participant completion rates for self-reported outcomes were low, the MaRISS PRO Tool showed moderate reliability. These findings should be confirmed in larger samples with a focus on improving participant engagemen

Abstract P4: Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: Results From the Mild and Rapidly Improving Stroke Study (mariss)

Background: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective is to describe multidimensional outcomes, identify predictors of worse outcomes and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or TIA presenting with stroke symptoms and a baseline NIHSS 0-5 within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale (mRS) 0-1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16 (SIS-16) and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines (GWTG)-Stroke participating hospitals (age 65 + 14, 42% women, final diagnosis ischemic stroke 90%, TIA 10%, 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, arm and leg weakness. Similar outcomes were noted for the alteplase-treated and the untreated groups. Alteplase treated patients were younger (64 + 13 vs. 67 + 1.4) with a higher NIHSS (2.9 + 1.4 vs. 1.7 + 1.4). After adjusting for age, sex, race-ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an effect on SIS-16 in the restricted sample of baseline NIHSS 3-5. Very few symptomatic hemorrhages were recorded (3/999). Conclusions: A large proportion of stroke patients presenting with a low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort but an indication of efficacy was noted in the NIHSS 3-5 subgroup

Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke.

BACKGROUND AND PURPOSE: Clinical fluctuations in ischemic stroke symptoms are common, but fluctuations before hospital arrival have not been previously characterized. METHODS: A standardized qualitative assessment of fluctuations before hospital arrival was obtained in an observational study that enrolled patients with mild ischemic stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) present on arrival to hospital within 4.5 hours of onset, in a subset of 100 hospitals participating in the Get With The Guidelines-Stroke quality improvement program. The number of fluctuations, direction, and the overall improvement or worsening was recorded based on reports from the patient, family, or paramedics. Baseline NIHSS on arrival and at 72 hours (or discharge if before) and final diagnosis and stroke subtype were collected. Outcomes at 90 days included the modified Rankin Scale, Barthel Index, Stroke Impact Scale 16, and European Quality of Life. Prehospital fluctuations were examined in relation to hospital NIHSS change (admission to 72 hours or discharge) and 90-day outcomes. RESULTS: Among 1588 participants, prehospital fluctuations, consisting of improvement, worsening, or both were observed in 35.5%: 25.1% improved once, 5.3% worsened once, and 5.1% had more than 1 fluctuation. Those who improved were less likely and those who worsened were more likely to receive alteplase. Those who improved before hospital arrival had lower change in the hospital NIHSS than those who did not fluctuate. Better adjusted 90-day outcomes were noted in those with prehospital improvement compared to those without any fluctuations. CONCLUSIONS: Fluctuations in neurological symptoms and signs are common in the prehospital setting. Prehospital improvement was associated with better 90-day outcomes, controlling for admission NIHSS and alteplase treatment. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02072681

Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS.

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