Evidence map›Paper›PMID 35012462›Full record

Trial reportBMC emergency medicine2022

Pre-hospital transdermal glyceryl trinitrate in patients with stroke mimics: data from the RIGHT-2 randomised-controlled ambulance trial.

Bronwyn Tunnage, Lisa J Woodhouse, Mark Dixon, Craig Anderson, Sandeep Ankolekar, Jason Appleton, Lesley Cala, Timothy England, Kailash Krishnan, Diane Havard and 15 more

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 20% 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

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
  5. Trial
  6. The hazards of chasing subgroups in neutral stroke trials.Neurological research and practice · 2025
    Review
  7. Article
  8. Review
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

25 authors at 16 institutions in 6 countries.

Bronwyn Tunnage *Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Lisa J Woodhouse *Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Mark DixonStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Craig AndersonThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, New South Wales, Australia.
Sandeep AnkolekarDepartment of Neurology, King's College Hospital NHS Foundation Trust, London, UK.
Jason AppletonStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Lesley CalaFaculty of Health and Medical Sciences, University of Western Australia, Perth, Australia.
Timothy EnglandVascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.
Kailash KrishnanStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Diane HavardStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Grant MairCentre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute at the University of Edinburgh, Chancellor's Building, Edinburgh, UK.
Keith MuirUniversity of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
Steve PhillipsDepartment of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, B3H 3A7, Canada.
John PotterBob Champion Research and Education Building, University of East Anglia, Norwich, UK.
Christopher PriceInstitute of Neuroscience, Newcastle University, Newcastle, UK.
Marc RandallDepartment of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Thompson G RobinsonDepartment of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Christine RoffeStroke Research in Stoke, Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK.
Else SandsetDepartment of Neurology, Oslo University Hospital, Oslo, Norway.
Niro SiriwardenaEast Midlands Ambulance Service NHS Trust, Nottingham, NG8 6PY, UK.
Polly ScuttStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Joanna M WardlawCentre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute at the University of Edinburgh, Chancellor's Building, Edinburgh, UK.
Nikola SpriggStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK.
Philip M BathStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG5 1PB, UK. philip.bath@nottingham.ac.uk.ORCID 0000-0003-2734-5132
RIGHT-2 Investigators
University of Nottingham · GBNottingham University Hospitals NHS Trust · GBUK Dementia Research Institute · GBDalhousie University · CAEast Midlands Ambulance Service NHS Trust · GBKeele University · GBKing's College Hospital NHS Foundation Trust · GBLeeds Teaching Hospitals NHS Trust · GBNewcastle University · GBOslo University Hospital · NOPeking University · CNQueen Elizabeth University Hospital · GBThe University of Western Australia · AUUniversity Hospitals Birmingham NHS Foundation Trust · GBUniversity of East Anglia · GBUniversity of Leicester · GB

Funding

British Heart Foundation CS/14/4/30972Medical Research Council MR/N003403/1
6 · The paper itself

Abstract

backgroundPrehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2).

methodsRIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days.

resultsAmong 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event.

conclusionsOne-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm.

trial registrationThis trial is registered with International Standard Randomised Controlled Trials Number ISRCTN 26986053 .

Indexed as

Brain IschemiaStrokeAdultAgedAmbulancesHospitalsHumansNitroglycerinProspective StudiesTreatment OutcomeNitroglycerinAmbulanceFunctional strokeGlyceryl trinitrateMigraineMimicNitroglycerinParamedicSeizuresStroke

Identifiers

PMID35012462
PMCPMC8744321
OpenAlexW4220840654

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.