Evidence map›Paper›PMID 32807487›Full record

ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2020

Routine use of FLAIR-negative MRI in the treatment of unknown onset stroke.

Malik M Adil, Marie Luby, John K Lynch, Amie W Hsia, Chandni P Kalaria, Zurab Nadareishvili, Lawrence L Latour, Richard Leigh

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. Article
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

8 authors.

Malik M AdilNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States.
Marie LubyNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States. Electronic address: lubym@ninds.nih.gov.
John K LynchNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States. Electronic address: lynchj@ninds.nih.gov.
Amie W HsiaNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States; MedStar Washington Hospital Center, Washington, DC, United States. Electronic address: hsiaa@ninds.nih.gov.
Chandni P KalariaNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States; MedStar Washington Hospital Center, Washington, DC, United States. Electronic address: Chandni.P.Kalaria@medstar.net.
Zurab NadareishviliNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Lawrence L LatourNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States. Electronic address: LatourL@ninds.nih.gov.
Richard LeighNational Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, United States; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States. Electronic address: richard.leigh@nih.gov.

Funding

Using MRI to Understand Disease States that Occur at the Interface of the Brain and the Cerebral CirculationZIANS003151 · NINDS · NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE · PI LEIGH, RICHARD · 2015 to 2023
$6.8M
Intramural NIH HHS ZIA NS003151
6 · The paper itself

Abstract

backgroundTreatment of FLAIR-negative stroke in patients presenting in an unknown time window has been shown to be safe and effective. However, implementation can be challenging due to the need for hyper-acute MRI screening. The purpose of this study was to review the routine application of this practice outside of a clinical trial.

methodsPatients presenting from 3/1/16 to 8/22/18 in a time window <4.5 h from symptom discovery but >4.5 h from last known normal were included if they had a hyper-acute MRI performed. Quantitative assessment based on the MR WITNESS trial and qualitative assessment based on the WAKE-UP trial were used to grade the FLAIR images. The MR WITNESS trial used a quantitative assessment of FLAIR change where the fractional increase in signal change had to be <1.15, whereas the WAKE-UP trial used a visual assessment requiring the absence of marked FLAIR signal changes.

resultsDuring the study period, 136 stroke patients presented and were imaged in the specified time window. Of these, 17 (12.5%) received IV tPA. Three patients had hemorrhage on 24-h MRI follow up; none had an increase in NIHSS ≥4. Of the 119 patients who were screened but not treated, 18 (15%) were eligible based on FLAIR quantitative assessment and 55 (46%) were eligible based on qualitative assessment. In all cases where patients were not treated, there was an identifiable exclusion based on trial criteria. During the study period, IV tPA utilization was increased by 5.6% due to screening and treating patients with unknown onset stroke.

conclusionsScreening stroke patients in an unknown time window with MRI is practical in a real-world setting and increases IV tPA utilization.

Indexed as

Magnetic Resonance ImagingThrombolytic TherapyAgedAged, 80 and overClinical Decision-MakingFemaleFibrinolytic AgentsHumansMaleMiddle AgedPatient SelectionPredictive Value of TestsRegistriesRetrospective StudiesStrokeTime FactorsFibrinolytic AgentsTissue Plasminogen ActivatorFLAIR negativeMRIThrombolysisUnknown onset

Identifiers

PMID32807487
PMCPMC9262008

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.