Evidence map›Paper›PMID 28798261›Full record

ArticleStroke2017

Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke.

Christel Renoux, Janie Coulombe, Linxin Li, Aravind Ganesh, Louise Silver, Peter M Rothwell, Oxford Vascular Study

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 2 pooled it
4.0field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Christel RenouxFrom the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (C.R., J.C.); Departments of Neurology and Neurosurgery (C.R.) and Epidemiology and Biostatistics (C.R.), McGill University, Montréal, Québec, Canada; and Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (C.R., L.L., A.G., L.S., P.M.R.). christel.renoux@mcgill.ca.
Janie CoulombeFrom the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (C.R., J.C.); Departments of Neurology and Neurosurgery (C.R.) and Epidemiology and Biostatistics (C.R.), McGill University, Montréal, Québec, Canada; and Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (C.R., L.L., A.G., L.S., P.M.R.).
Linxin LiFrom the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (C.R., J.C.); Departments of Neurology and Neurosurgery (C.R.) and Epidemiology and Biostatistics (C.R.), McGill University, Montréal, Québec, Canada; and Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (C.R., L.L., A.G., L.S., P.M.R.).
Aravind GaneshFrom the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (C.R., J.C.); Departments of Neurology and Neurosurgery (C.R.) and Epidemiology and Biostatistics (C.R.), McGill University, Montréal, Québec, Canada; and Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (C.R., L.L., A.G., L.S., P.M.R.).
Louise SilverFrom the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (C.R., J.C.); Departments of Neurology and Neurosurgery (C.R.) and Epidemiology and Biostatistics (C.R.), McGill University, Montréal, Québec, Canada; and Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (C.R., L.L., A.G., L.S., P.M.R.).
Peter M RothwellFrom the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (C.R., J.C.); Departments of Neurology and Neurosurgery (C.R.) and Epidemiology and Biostatistics (C.R.), McGill University, Montréal, Québec, Canada; and Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (C.R., L.L., A.G., L.S., P.M.R.).
Oxford Vascular Study
Jewish General Hospital · CA

Funding

Wellcome Trust 104040
6 · The paper itself

Abstract

background and purposeSeveral studies have reported unexplained worse outcomes after stroke in women but none included the full spectrum of symptomatic ischemic cerebrovascular events while adjusting for prior handicap.

methodsUsing a prospective population-based incident cohort of all transient ischemic attack/stroke (OXVASC [Oxford Vascular Study]) recruited between April 2002 and March 2014, we compared pre-morbid and post-event modified Rankin Scale score (mRS) in women and men and change in mRS score 1 month, 6 months, 1 year, and 5 years after stroke. Baseline stroke-related neurological impairment was measured with the National Institutes of Health Stroke Scale.

resultsAmong 2553 patients (50.6% women) with a first transient ischemic attack/ischemic stroke, women had a worse handicap 1 month after ischemic stroke (age-adjusted odds ratio for mRS score, 1.35; 95% confidence interval, 1.12-1.63). However, women also had a higher pre-morbid mRS score compared with men (age-adjusted odds ratio, 1.58; 95% confidence interval, 1.36-1.84). There was no difference in stroke severity when adjusting for age and pre-morbid mRS (odds ratio, 1.10; 95% confidence interval, 0.90-1.35) and no difference in the pre-/poststroke change in mRS at 1 month (age-adjusted odds ratio, 1.00; 95% confidence interval, 0.82-1.21), 6 months, 1 year, and 5 years. Women had a lower mortality rate, and there was no sex difference in risk of recurrent stroke.

conclusionsWe found no evidence of a worse outcome of stroke in women when adjusting for age and pre-morbid mRS. Failure to account for sex differences in pre-morbid handicap could explain contradictory findings in previous studies. Properties of the mRS may also contribute to these inconsistencies.

Indexed as

Population SurveillanceRecovery of FunctionSeverity of Illness IndexSex CharacteristicsAdultAgedAged, 80 and overCohort StudiesFemaleHumansMaleMiddle AgedProspective StudiesStrokeTreatment OutcomeUnited Kingdomepidemiologyprognosissexstrokewomen

Identifiers

PMID28798261
PMCPMC5610564
OpenAlexW2745205964

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.