No benefit of flat head positioning in early moderate–severe acute ischaemic stroke: a HeadPoST study subgroup analysis
Journal
Stroke and Vascular Neurology
ISSN
2059-8688
2059-8696
Date Issued
2020
Author(s)
Menglu Ouyang
Hisatomi Arima
Pablo M Lavados
Thompson Robinson
Laurent Billot
Marre L Hackett
Lili Song
Sandy Middleton
Octavio Pontes-Neto
Tsong-Hai Lee
Caroline Watkins
Craig S Anderson
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Early FP had no significant effect in patients with moderate–severe AIS.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT02162017">NCT02162017</jats:ext-link>.</jats:p></jats:sec>
Cite this document
Brunser, A. M., Ouyang, M., Arima, H., Lavados, P. M., Robinson, T., Muñoz-Venturelli, P., Olavarría, V. V., Billot, L., Hackett, M. L., Song, L., Middleton, S., Pontes-Neto, O., Lee, T.-H., Watkins, C., & Anderson, C. S. (2020). No benefit of flat head positioning in early moderate–severe acute ischaemic stroke: A HeadPoST study subgroup analysis. Stroke and Vascular Neurology, 5(4), 406-409. https://doi.org/10.1136/svn-2020-000387
Subjects
stroke
;
aged
;
aged, 80 and over
;
disability evaluation
;
female
;
functional status
;
humans
;
ischemic stroke
;
male
;
middle aged
;
patient positioning
;
recovery of function
;
severity of illness index
;
sitting position
;
supine position
;
time factors
;
treatment outcome
;
aged
;
article
;
brain ischemia
;
controlled study
;
crossover procedure
;
disability
;
female
;
head position
;
human
;
major adverse cardiac event
;
major clinical study
;
male
;
multicenter study
;
national institutes of health stroke scale
;
open study
;
post hoc analysis
;
randomized controlled trial
;
rankin scale
;
risk factor
;
brain ischemia
;
clinical trial
;
comparative study
;
convalescence
;
functional status
;
middle aged
;
pathophysiology
;
patient positioning
;
severity of illness index
;
sitting
;
supine position
;
time factor
;
treatment outcome
;
very elderly