Midline Shift Greater than 3 mm Independently Predicts Outcome After Ischemic Stroke

Background Cerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acut...

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Bibliographic Details
Published in:Neurocritical care 2022-02, Vol.36 (1), p.46-51
Main Authors: McKeown, Morgan E., Prasad, Ayush, Kobsa, Jessica, Top, Ilayda, Snider, Samuel B., Kidwell, Chelsea, Campbell, Bruce C. V., Davis, Stephen M., Donnan, Geoffrey A., Lev, Michael, Sheth, Kevin N., Petersen, Nils, Kimberly, W. Taylor, Bevers, Matthew B.
Format: Article
Language:English
Subjects:
Age
Brain Edema - complications
Brain Edema - etiology
Brain Ischemia - complications
Brain Ischemia - diagnostic imaging
Brain Ischemia - therapy
Clinical significance
Confidence intervals
Critical Care Medicine
Diabetes
Edema
Glucose
Humans
Hypertension
Intensive
Internal Medicine
Ischemia
Ischemic Stroke
Magnetic resonance imaging
Medicine
Medicine & Public Health
Neurology
Neurosurgery
Original Work
Patients
Sensitivity analysis
Stroke - complications
Stroke - diagnostic imaging
Stroke - therapy
Thrombectomy
Tomography
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Background Cerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acute stroke. Methods Patient-level data from six acute stroke clinical trials were combined with endovascular thrombectomy registries from two academic referral centers, generating a combined cohort of 1977 patients. MLS was extracted from the original trial data or measured on computed tomography or magnetic resonance imaging that was obtained a median of 47.0 h (interquartile range 27.0–75.1 h) after stroke onset. Logistic regression was performed to identify predictors of poor outcome and the minimal clinically relevant MLS threshold. Results The presence of MLS was a predictor of poor outcome, independent of baseline clinical and demographic factors (adjusted odds ratio 4.46, 95% confidence interval 3.56–5.59, p  
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-021-01341-x