Evidence map›Paper›PMID 35169010›Full record

ArticleNeurology2022

Association of Acute Alteration of Consciousness in Patients With Acute Ischemic Stroke With Outcomes and Early Withdrawal of Care.

Ayham Alkhachroum, Antonio J Bustillo, Negar Asdaghi, Hao Ying, Erika Marulanda-Londono, Carolina M Gutierrez, Daniel Samano, Evie Sobczak, Dianne Foster, Mohan Kottapally and 7 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
–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

16 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Review
  3. Article
  4. Observational
  5. Observational
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. The Current of Consciousness: Neural Correlates and Clinical Aspects.Current neurology and neuroscience reports · 2023
    Review
  14. Prognosis of consciousness disorders in the intensive care unit.Presse medicale (Paris, France : 1983) · 2023
    Review
  15. Article
  16. 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

17 authors.

Ayham AlkhachroumFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.ORCID 0000-0003-0352-5913
Antonio J BustilloFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.ORCID 0000-0002-9115-7382
Negar AsdaghiFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Hao YingFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Erika Marulanda-LondonoFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Carolina M GutierrezFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Daniel SamanoFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Evie SobczakFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Dianne FosterFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Mohan KottapallyFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Amedeo MerendaFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Sebastian KochFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Jose G RomanoFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Kristine O'PhelanFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Jan ClaassenFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Ralph L SaccoFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.
Tatjana RundekFrom the Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), University of Miami; Department of Neurology (A.A., A.J.B., N.A., H.Y., E.M.-L., C.M.G., D.S., E.S., M.K., A.M., S.K., J.G.R., K.O., R.L.S., T.R.), Jackson Memorial Hospital, Miami, FL; Regional Director Quality Improvement (D.F.), American Heart Association, Marietta, GA; and Department of Neurology (J.C.), Columbia University, New York, NY.ORCID 0000-0002-7115-9815

Funding

The Data Management and BiostatisticsU54NS081763 · NINDS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI SACCO, RALPH L. · 2013 to 2017
$4.2M
RECONFIG - REcovery of CONsciousness Following Intracerebral hemorrhaGeR01NS106014 · NINDS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI CLAASSEN, JAN · 2019 to 2023
$3.6M
BAsIC - Brain-computer-interface practical Application in the Intensive Care unit: a pilot studyR03NS112760 · NINDS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI CLAASSEN, JAN · 2019 to 2020
$162k
NINDS NIH HHS R01 NS106014NINDS NIH HHS R03 NS112760NINDS NIH HHS U54 NS081763
6 · The paper itself

Abstract

BACKGROUND AND

objectivesEarly consciousness disorder (ECD) after acute ischemic stroke (AIS) is understudied. ECD may influence outcomes and the decision to withhold or withdraw life-sustaining treatment.

methodsWe studied patients with AIS from 2010 to 2019 across 122 hospitals participating in the Florida Stroke Registry. We studied the effect of ECD on in-hospital mortality, withholding or withdrawal of life-sustaining treatment (WLST), ambulation status on discharge, hospital length of stay, and discharge disposition.

resultsOf 238,989 patients with AIS, 32,861 (14%) had ECD at stroke presentation. Overall, average age was 72 years (Q1 61, Q3 82), 49% were women, 63% were White, 18% were Black, and 14% were Hispanic. Compared to patients without ECD, patients with ECD were older (77 vs 72 years), were more often female (54% vs 48%), had more comorbidities, had greater stroke severity as assessed by the National Institutes of Health Stroke Scale (score ≥5 49% vs 27%), had higher WLST rates (21% vs 6%), and had greater in-hospital mortality (9% vs 3%). Using adjusted models accounting for basic characteristics, patients with ECD had greater in-hospital mortality (odds ratio [OR] 2.23, 95% CI 1.98-2.51), had longer hospitalization (OR 1.37, 95% CI 1.33-1.44), were less likely to be discharged home or to rehabilitation (OR 0.54, 95% CI 0.52-0.57), and were less likely to ambulate independently (OR 0.61, 95% CI 0.57-0.64). WLST significantly mediated the effect of ECD on mortality (mediation effect 265; 95% CI 217-314). In temporal trend analysis, we found a significant decrease in early WLST (<2 days) (R DISCUSSION: In this large prospective multicenter stroke registry, patients with AIS presenting with ECD had greater mortality and worse discharge outcomes. Mortality was largely influenced by the WLST decision.

Indexed as

Brain IschemiaIschemic StrokeStrokeAgedConsciousnessFemaleHospital MortalityHumansProspective Studies

Identifiers

PMID35169010
PMCPMC8992606

What OpenQuestion holds

Textmetadata
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.