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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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posted on 2021-03-23, 15:51 authored by Alejandro M Brunser, Menglu Ouyang, Hisatomi Arima, Pablo M Lavados, Thompson Robinson, Paula Muñoz-Venturelli, Verónica V Olavarría, Laurent Billot, Marre L Hackett, Lili Song, Sandy Middleton, Octavio Pontes-Neto, Tsong-Hai Lee, Caroline Watkins, Craig S Anderson
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 severity.

Methods 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 event. Logistic regression analyses were undertaken adjusted for study design and baseline risk factors.

Results 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.

History

Citation

Stroke and Vascular Neurology 2020;5:doi: 10.1136/svn-2020-000387

Author affiliation

Department of Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

Stroke and vascular neurology

Volume

5

Publisher

BMJ

issn

2059-8688

eissn

2059-8696

Acceptance date

2020-05-28

Copyright date

2021

Available date

2021-03-23

Spatial coverage

England

Language

eng

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