ArticleClinical neuroradiology2025
Pre-stroke Functional Status in Patients Undergoing Mechanical Thrombectomy: How Relevant Are False Estimations in the Emergency Setting?
Article in Clinical neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe modified Rankin scale (mRS) is frequently used in the emergency setting to estimate pre-stroke functional status in stroke patients who are candidates to acute revascularization therapies (ps-mRS). We aimed to describe the agreement between pre-stroke mRS evaluated in the emergency department (ED-ps-mRS) and pre-stroke mRS evaluated comprehensively post-admission (PA-ps-mRS).
methodsRetrospective study of consecutive ischemic stroke patients undergoing mechanical thrombectomy, with available ED-ps-mRS and PA-ps-mRS. ED-ps-mRS was evaluated by the treating neurologist and documented in the emergency stroke treatment protocol. PA-ps-mRS was retrospectively evaluated with information registered in the clinical record. Collection of baseline characteristics and 3‑month outcomes. Patients with ED-overestimated pre-stroke functional status (ED ps-mRS ≤ 2 and PA-ps-mRS ≥ 3) were compared to correct low and high ED-ps-mRS groups.
resultsWe included 409 patients (median age 77 years, 50% female, median NIHSS 14). Concordance of dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) was found in 81.4% (Cohen's kappa = 0.476, p < 0.001). ED-overestimated pre-stroke functional status was found in 69 patients (17%). Patients with ED-overestimated pre-stroke functional status were older (p < 0.001), more frequently presented diabetes (p < 0.001), previous stroke (p = 0.014) and less frequently presented 3‑month functional independence (p < 0.001) compared to patients with correct low ED-ps-mRS. No differences in pre-stroke baseline characteristics between overestimated and correct high ED-ps-mRS was found.
conclusionDisagreement between dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) occurred in 1/5 of patients. Overestimation of pre-stroke functional status may falsely reduce the expected proportion of patients achieving favourable 3‑month functional outcomes.
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