London, United Kingdom 2013 8 Acute stroke: clinical patterns and practice 17:40 - 17:50 Clinical and Radiological Predictors of Anterior vs. Posterior circulation Large Vessel Oc-clusion in Acute Ischemic Strokes P. Vanacker1, M. Faouzi2, A. Eskandari3, P. Michel4 Centre Hospitalier Universitaire Vaudois, Lausanne, SWITZERLAND1,Centre Hospitalier Universitaire Vaudois, Lausanne, SWITZERLAND2, Centre Hospitalier Universitaire Vaudois, Lausanne, SWITZERLAND3, Centre Hospitalier Universitaire Vaudois, Lausanne, SWITZER-LAND4 Objective: Early detection of an acute large vessel occlusion (LVO) in respectively the anteri-or or posterior circulation could influence the acute treatment strategy in acute ischemic stroke (AIS). Our objective was to identify readily available clinical and radiological data to localiz-ing ischemia to the anterior vs. posterior circulation (AC vs. PC) in patients with AIS and LVO. Methods: We selected all consecutive patients (2003 – 2011) in the Acute STroke Registry and Analysis of Lausanne, a prospective, observational single-center registry of AIS who had symp-tomatic occlusion on CT angiography <12h after stroke onset. Data on demographics, risk fac-tors, co-morbidities, neurological examination, CT and occlusion characteristics were collected. Stroke was localized to AC or PC using all available radiological information from acute and follow-up imaging, and clinical information if needed. Results: Of 1645 patients analyzed, 6% were excluded because of the inability to localize the stroke and 2% because of simultaneous AC and PC strokes. In the remaining 1523 patients, LVO was seen in 630/1136 (56%) of AC and 127/387 (33%) of PC AIS. In multiple logistic regression analysis, LVO in the AC was associated with presence of aphasia (OR 53.1, 95%CI 16.1-175.9), hemineglect (32.2, 10.4-99.8), hemiparesis (4.8, 1.3-17.4), and hemisensory defi-cits (6.3, 2.6-15.3), whereas PC localization with presence of cerebellar (0.1,0.0-0.1) and visual field defects (0.1,0.0-0.2). AC strokes with LVO had higher admission diastolic blood pressure (1.1,1.0-1.1), shorter onset-to-door interval (0.9,0.9-1.0) and less often a normal admission CT (0.7, 0.5-0.9). Conclusion: In patient with stroke with LVO, posterior circulation localization can be inferred by later presentation to the hospital, less cognitive, sensory-motor and more cerebellar deficits, lower acute blood pressure, and normal non-contrast CT. This information may help target the recanalisation treatment in AIS patients. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 171 7 Acute stroke: clinical patterns and practice 17:30 - 17:40 Nutrition screening tools can predict poor outcomes at one month in patients who have had a stroke V.C. Aubrey1, F. Gomes2, C.E. Weekes3 King’s Collage London, London, UNITED KINGDOM1,King’s Collage London, London, UNITED KINGDOM2, Guy’s and St Thomas’ NHS foundation trust, London, UNITED KING-DOM3 Background Nutrition screening tools (NSTs) are routinely used to identify patients requiring further nutritional assessment and possible intervention. This study tested the predictive validity of two NSTs in acute stroke patients. Method Patients admitted to St Thomas’ Hospital with acute stroke were assessed using two NSTs; MUST (Elia, 2003) and Guy’s & St Thomas’ (GST) (Weekes et al 2004) if they were in hospital more than 3 days. Both tools assessed BMI, recent weight loss and dietary intake. Outcome data (mortality, discharge destination and length of hospital stay (LOS)) were collect-ed retrospectively from hospital records at one month post stroke. The tools categorised patients into low, medium or high risk of malnutrition. Low/medium risk category was combined for comparison with the high-risk category. Statistical analyses were conducted using Fisher’s Ex-act test and logistic regression (SPSS v18.0). Results 158 patients were recruited; 79 (50 %) male; mean age 72.4 (SD 13.8) years; NIHSS score 10.2 (SD 6.4). Eighteen patients were excluded from the analysis; lack of discharge infor-mation (n = 14); MUST incomplete (n = 4). Using MUST there were significant relationships for mortality (p = 0.000) and LOS (p=0.033) with increased patient deaths and longer LOS in the high-risk category. No significant relationship was observed for discharge destination (p=0.09). Using GST there were significant relationships between risk category and mortality, LOS and discharge destination (Table 1). Patients in the high-risk category had poorer out-comes. For both tools the relationships remained significant after adjustment for age, gender and stroke severity (log regression, p< 0.05). Conclusion Both MUST and GST reliably predict poor outcomes in stroke patients at one month. Research is needed to determine if nutrition interventions implemented following nutri-tion screening result in better outcomes in high-risk patients who have had a stroke. Elia M (2003) BAPEN Weekes CE et al (2004) Clinical Nutrition, 23:1104-12 Table 1: Guys and St Thomas’ NST Risk of mal-nutrition Mortality (n=158) (p=0.000)* Discharge (n= 144) (p=0.015)* LOS in weeks (n=158) (p=0.021)* Dead Alive Low care High care 1-2 3-4 Low/medi-um (n=91) 0 (0%) 91 (100%) 22 (25%) 67 (75%) 50 (55%) 41 (45%) High (n=67) 12 (18%) 55 (82%) 5 (9%) 50 (91%) 25 (37%) 42 (63%) *Fisher’s Exact test
Karger_ESC London_2013
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