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No benefit of flat head positioning in early moderate-severe acute ischaemic stroke: a HeadPoST study subgroup analysis

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Stroke & Vascular Neurology 2020年第4期5卷 406-409页

作者： Alejandro M Brunser Menglu Ouyang Hisatomi Arima Pablo M Lavados Thompson Robinson Paula Munoz-Venturelli Veronica V Olavarria Laurent Billot Marre L Hackett Lili Song sandy middleton Octavio Pontes-Neto Tsong-Hai Lee Caroline Watkins Craig S Anderson Department of General Emergency Clinica Alemana de SantiagoClinica Alemana Universidad del DesarrolloSantiagoChile Department of Neurology and Psychiatry Clinica Alemana de SantiagoFaculty of MedicineClinica Alemana Universidad del DesarrolloSantiagoChile The George Institute for Global Health University of New South WalesSidneyNew South WalesAustralia The George Institute in China Peking University Health Science CenterBeijingChina Department of Preventive Medicine and Public Health Fukuoka UniversityFukuokaJapan Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre University of LeicesterLeicesterUnited Kingdom Faculty of Health and Wellbeing University of Central LancashirePrestonLancashireUnited Kingdom Nursing Research Institute St Vincent's Health Network Sydney AustraliaAustralian Catholic UniversitySydneyNew South WalesAustralia Stroke Service-Neurology Division Department of Neuroscience and Behavioral SciencesRibeirao Preto Medical SchoolUniversity of Sao PauloSao PauloBrazil Stroke Center and Department of Neurology Linkou Chang Gung Memorial Hospital and College of MedicineChang Gung UniversityTaoyuanTaiwan

background Although the Head Positioning in acute Stroke Trial(HeadPoST)showed no effect of the flat head position(FP;vs sitting up head position(SUP))on functional outcome,we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke(AIS)of at least moderate *** Subgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale(NIHSS)scores≥7,≥10 and≥14,randomised to FP or SUP<4.5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale(mRS)and death/disability(mRS scores 3-6),and any cardiovascular serious adverse *** regression analyses were undertaken adjusted for study design and baseline risk *** There was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores:adjusted OR and 95%CI for ordinal shift and binary(3-6)mRS scores:for NIHSS≥7(n=867)0.92(0.67 to 1.25)and 0.74(0.52 to 1.04);NIHSS≥10(n=606)0.80(0.58 to 1.10)and 0.77(0.49 to 1.19);NIHSS≥14(n=378)0.82(0.54 to 1.24)and 1.22(0.69 to 2.14).Conclusions Early FP had no significant effect in patients with moderate-severe AIS.

关键词： acute analysis effect

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