Global Outcome Assessment Life-long after stroke in young adults initiative-the GOAL initiative : study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

Introduction Worldwide, 2 million patients aged 18-50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients. Methods and analysis The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Peer reviewe

Risk factors and prognosis of young stroke. The FUTURE study: A prospective cohort study. Study rationale and protocol

Contains fulltext : 98322.pdf (postprint version ) (Open Access)BACKGROUND: Young stroke can have devastating consequences with respect to quality of life, the ability to work, plan or run a family, and participate in social life. Better insight into risk factors and the long-term prognosis is extremely important, especially in young stroke patients with a life expectancy of decades. To date, detailed information on risk factors and the long-term prognosis in young stroke patients, and more specific risk of mortality or recurrent vascular events, remains scarce. METHODS/DESIGN: The FUTURE study is a prospective cohort study on risk factors and prognosis of young ischemic and hemorrhagic stroke among 1006 patients, aged 18-50 years, included in our study database between 1-1-1980 and 1-11-2010. Follow-up visits at our research centre take place from the end of 2009 until the end of 2011. Control subjects will be recruited among the patients' spouses, relatives or social environment. Information on mortality and incident vascular events will be retrieved via structured questionnaires. In addition, participants are invited to the research centre to undergo an extensive sub study including MRI. DISCUSSION: The FUTURE study has the potential to make an important contribution to increase the knowledge on risk factors and long-term prognosis in young stroke patients. Our study differs from previous studies by having a maximal follow-up of more than 30 years, including not only TIA and ischemic stroke but also hemorrhagic stroke, the addition of healthy controls and prospectively collect data during an extensive follow-up visit. Completion of the FUTURE study may provide better information for treating physicians and patients with respect to the prognosis of young stroke.8 p

Comparisons between hemispheric stroke patients with normal ipsilateral hippocampal volume and high versus low ipsilateral hippocampal MD.

<p>Data are presented as number or adjusted mean (±SEM).</p><p>^aComparison between left-hemispheric stroke patients with low left hippocampal MD versus high left hippocampal MD.</p><p>^bComparison between right-hemispheric stroke patients with low right hippocampal MD versus high right hippocampal MD. For the analyses on hippocampal volume we adjusted for age, sex, and follow-up duration. For the analyses on ipsilateral hippocampal MD we additionally adjusted for ipsilateral hippocampal volume. For the analyses on immediate and delayed verbal recall we adjusted for age, sex, education, follow-up duration, and ipsilateral hippocampal volume.</p><p>MD = Mean Diffusivity.</p><p>Comparisons between hemispheric stroke patients with normal ipsilateral hippocampal volume and high versus low ipsilateral hippocampal MD.</p

Presence of baseline factors in patients with incident diabetes or impaired fasting glucose at follow-up.

<p>Abbreviations: IFG, impaired fasting glucose; TIA, transient ischemic attack; SD, standard deviation; NIHSS, National Institute of Health Stroke Scale; IQR, interquartile range; TOAST, Trial of Org 10172 in Acute Stroke Treatment.</p><p>Data are given as number (percentage) or otherwise stated</p>*<p><i>p</i> values refer to a comparison between patients with incident diabetes and patients with no IFG or diabetes</p>†<p><i>p</i> values refer to a comparison between patients with IFG and patients with no IFG or diabetes</p>‡<p>Scores range from 0 to 42 with higher scores on the scale indicating worse stroke severity. 0.4% of NIHSS was missing.</p>§<p>Smoking was defined as smoking at least 1 cigarette a day in the year prior to the event. 2.9% of data on smoking was missing.</p>||<p>Excess alcohol consumption was defined as consuming more than 200 grams of pure alcohol per week</p>¶<p>First degree family member. 1.0% of data on family history of diabetes was missing.</p

Lesion probability maps in patients with left-hemispheric stroke, right-hemispheric stroke, and infratentorial stroke.

<p>The color overlay created on top of the Montreal Neurologic Institute (MNI) standard brain template shows the probability of each voxel containing a lesion in each patient group. The color bar denotes the probability range.</p

Demographic and clinical characteristics of ischemic stroke patients and controls.

<p>Data are expressed as mean (SD), number (%), or median (Q1–Q3).</p><p>NIHSS = National Institutes of Health Stroke Scale</p><p>mRS = modified Rankin Scale.</p><p>HADS = Hospital Anxiety and Depression Scale</p><p>CIS-20R = Checklist Individual Strength.</p><p>TOAST = Trial of Org 10172 in Acute Stroke Treatment.</p><p>Missing data in patients: education = 0.7%, NIHSS at admission = 1.4%</p><p>HADS-depressive symptoms = 0.7%, CIS-20R = 0.7%.</p><p>^aStroke could be located in more than one region in a patient.</p><p>^bGroup comparisons between the three groups of patients (left/right/infratentorial stroke).</p><p>Demographic and clinical characteristics of ischemic stroke patients and controls.</p

Baseline characteristics of patients.

<p>Abbreviations: TIA, transient ischemic attack; SD, standard deviation; NIHSS, National Institute of Health Stroke Scale; IQR, interquartile range; TOAST, Trial of Org 10172 in Acute Stroke Treatment.</p><p>Data are given as number (percentage) or otherwise stated</p>*<p>Scores range from 0 to 42 with higher scores on the scale indicating worse stroke severity. 0.5% of NIHSS was missing.</p>†<p>Smoking was defined as smoking at least 1 cigarette a day in the year prior to the event. 1.9% of data on smoking was missing.</p>‡<p>Excess alcohol consumption was defined as consuming more than 200 grams of pure alcohol per week</p>§<p>First degree family member. 0.9% of data on family history of diabetes was missing.</p