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Neurology. 2016 Aug 23;87(8):782-5. doi: 10.1212/WNL.0000000000002964. Epub 2016 Jul 13.

Role of emergent chest radiography in evaluation of hyperacute stroke.

Author information

1
From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
2
From the Department of Neurology (H.S.), Wayne State University School of Medicine, Detroit, MI; Department of Neurology (B.S.), Warren Alpert Medial School, Brown University; Comprehensive Stroke Center (B.S.), Rhode Island Hospital, Providence; Department of Neurology (A.S., V.M., R.B.), School of Medicine, University of Texas Health Science Center, San Antonio; and Department of Clinical Neurological Sciences (M.R.A.), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Behrouz@uthscsa.edu.

Abstract

OBJECTIVE:

To use data from a large multicenter trial to assess the role and significance of chest radiograph (CXR) in the initial evaluation of acute stroke.

METHODS:

Predefined clinical characteristics of patients who had recorded data on CXR examination during the initial evaluation were collected. We compared features of patients who had a CXR done before IV thrombolytics with those who did not. Rates of adverse cardiopulmonary events, intubation, and in-hospital mortality were also compared. Logistic regression analysis was performed to evaluate for the association of CXR performance with door-to-needle time ≥60 minutes.

RESULTS:

In a cohort of 615 patients, 243 had CXR done before IV thrombolytics. Patients with CXR before treatment had significantly higher admission neurologic deficit, initial respiratory rates, and door-to-needle time than those with CXR after treatment. The rates of cardiopulmonary adverse events in the first 24 hours of admission, endotracheal intubation in the first 7 hours, and in-hospital mortality were not different between the 2 groups. Patients with CXR done before treatment had longer mean door-to-needle times than those without pretreatment radiography (75.8 vs 58.3 minutes, p = 0.0001). Performance of CXR was independently associated with door-to-needle time ≥60 minutes (odds ratio 2.78, 95% confidence interval 1.97-3.92; p = 0.00001).

CONCLUSIONS:

Performance of CXR prior to IV thrombolytics prolongs door-to-needle time in acute ischemic stroke patients. CXR before treatment should be reserved for situations wherein acute cardiopulmonary conditions would otherwise preclude the administration of IV thrombolytics or substantially influence management.

PMID:
27412145
DOI:
10.1212/WNL.0000000000002964
[Indexed for MEDLINE]

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