Purpose In comatose patients at risk of death by neurologic criteria (DNC), spinal-mediated movements (SMM) and movements of unclear neuroanatomic origin (MUO) are occasionally challenging to discriminate from cerebral-mediated movements. Our objectives were to assess the respective prevalence and semiology of SMM and of MUO in this population and to estimate the associations between these movements with cerebral blood flow and perfusion.Methods In this prospective cohort study conducted in 15 intensive care units across Canada, we enrolled consecutive, brain-injured adults with an unconfounded Glasgow Coma Scale score of 3. Physicians conducted standardized DNC clinical evaluation, and participants underwent a brain CT-perfusion scan with CT-angiography reconstructions within a 2-h delay. We assessed the prevalence and semiology of SMM and MUO with descriptive statistics. We estimated the associations between SMM and MUO with cerebral blood flow and brain perfusion using generalized linear mixed models with a logit link function, age and sex as covariates, and random intercepts for study sites.Results We included 282 participants with a median [IQR] age of 60 [47-69] years. The respective prevalence of SMM and MUO were 27% (95% CI: 22-32%) and 12% (95% CI: 9-16%). SMM and MUO were not associated with the presence of cerebral blood flow on CT-angiography (aOR for SMM: 1.14, 95% CI: 0.63-2.05; aOR for MUO: 1.36, 95% CI: 0.61-3.01) or brain perfusion on CT-perfusion (aOR for SMM: 1.44, 95% CI: 0.77-2.68; aOR for MUO: 1.75, 95% CI: 0.77-3.97). Findings were similar in the subgroup of 204 patients fulfilling clinical criteria for DNC.Conclusions SMM and MUO are common among comatose patients at risk of DNC. Their prevalence is similar among alive comatose patients and patients fulfilling clinical criteria for DNC. These movements are not associated with cerebral blood flow on CT-angiography or brain perfusion on CT-perfusion.Trial registration: Registered on ClinicalTrials.gov: NCT03098511 on March 27, 2017.

OBJECTIVES: Poor neurologic outcomes are common in post-cardiac arrest patients. Reduced cerebral perfusion and inadequate oxygen delivery may persist even following return of spontaneous circulation (ROSC), which may exacerbate hypoxic-ischemic brain injury. Cerebral oximetry is a noninvasive method of assessing brain oxygenation. We performed a systematic review to assess whether post-arrest regional oxygen saturation (rSO 2 ) during the initial 48 hours post-ROSC is associated with death or severe disability. DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, World Health Organization Global Health Library. STUDY SELECTION: We included studies reporting outcomes in adult post-arrest patients who underwent continuous cerebral oximetry immediately following ROSC for at least 6 hours. DATA EXTRACTION: rSO 2 over the 48 hours post-arrest was compared between patients with favorable vs. unfavorable outcomes, as dichotomized within individual studies. DATA SYNTHESIS: Random effects models were used to pool studies. 10,876 records were identified, of which 16, with a total of 864 patients, met inclusion criteria. Twelve studies provided neurologic outcomes, and four reported only survival. rSO 2 was similar at baseline, but higher at 24 hours (3.3%, 0.9–5.7%, p = 0.009) and 48 hours (2.1%, 0.3–3.9%, p = 0.02) post-arrest among patients with favorable outcomes. There was significant heterogeneity between studies. rSO 2 averaged over time was significantly higher between 24 and 48 hours in patients with favorable outcomes (5.2%, 1.6–8.8%; p = 0.005). rSO 2 was lower in studies where cardiac arrest duration was relatively longer (modeled difference –7.1%, –3.1% to –11.1%, p = 0.0005). Although very low rSO 2 had high specificity for unfavorable outcome in two studies, no consistent threshold could be identified for use in neuroprognostication. CONCLUSIONS: Current evidence suggests that rSO 2 during the initial 48 hours following ROSC is slightly lower in post-cardiac arrest patients with unfavorable neurologic outcomes (low certainty of evidence). Prospective research is needed to determine whether treatment of reduced rSO 2 can improve outcomes.

Controlled donation after circulatory determination of death (DCD) is feasible only if circulatory arrest occurs soon after withdrawal of life-sustaining measures (WLSM). When organ recovery cannot proceed because this time interval is too long, there are potential negative implications, including perceptions of “secondary loss” for patients’ families and significant resource consumption. The DCD-N score is a validated clinical tool for predicting rapid death following WLSM. We hypothesized that neuroimaging evidence of effaced perimesencephalic cisterns improves prediction of time to death compared with the DCD-N score alone. In a retrospective population-based cohort study, DCD-N scores were prospectively determined in patients for whom consent for DCD had been obtained. Perimesencephalic cisterns on last available neuroimaging were assessed in duplicate and classified as normal, partially effaced, or completely effaced. Multivariable logistic regression assessed the capacity of DCD-N score and effaced cisterns to predict death within 1, 2, or 3 h of WLSM. Of 164 consecutive patients, 49 (30

Importance:Donation physicians (DPs) are usually critical care specialists whose responsibilities may include assessment of donation eligibility, care of potential donors, death determination, education, and advocacy. While DP programs have been implemented in some countries with the aim of optimizing the organ donation process, there are few studies evaluating their effectiveness. Objective:To assess the association of a DP program with key performance metrics. Design, Setting, and Participants:This cohort study used interrupted time series analysis to compare baseline data from intensive care units and emergency departments in a Canadian province (December 2019 to February 2020 and March 2021 to May 2021) with data following the initial 3 years of a DP program (July 2021 to June 2024). Donation data included consecutive deceased critically ill patients with various forms of brain injury who received mechanical ventilation in the last 12 hours of life. Exposure:Implementation of a province-wide DP program coupled with regular audit and feedback aimed at identifying and minimizing missed donation opportunities. Main Outcomes and Measures:Missed organ donation opportunities, defined as occurring when families of eligible potential donors were not given the option of donation. Secondary outcomes included appropriate notification of the provincial donation organization, donors per million population, and median number of organs transplanted per donor. Results:Over 42 months, there were 1072 eligible potential donors, including 635 (59%) following death by neurologic criteria and 437 (41%) following death by circulatory criteria. The median (IQR) age was 44.6 (30.8-58.3) years, 662 (62%) were male, and the most common cause of death was hypoxic-ischemic brain injury. During the initial 36 months of the DP program, 129 of 942 (14%) eligible potential donors were missed, compared with 43 of 123 (33%) during 6 months of baseline data (P < .001). The monthly proportion of missed cases decreased by 10.9% (95% CI, -22.0% to 0.3%; P = .06) immediately following the start of the program and then declined -0.7% (95% CI, -0.9% to -0.5%; P < .001) per month. Appropriate notification of the provincial organ donation organization increased 0.9% (95% CI, 0.6% to 1.3%, P < .001) per month. The annual donation rate increased from 14.0 to 23.7 donors per million. The median (IQR) number of organs transplanted per donor did not change (4 [3-5]; P = .69). Missed opportunities occurred in 3% of eligible potential donors when the most responsible physician was a DP and 17% when it was not (P < .001). Conclusions:In this cohort study of consecutive eligible potential organ donors, implementation of a novel DP program was associated with a sustained reduction in missed organ donation opportunities, increased referrals, and a higher deceased donation rate.

The vast majority of patients with minor stroke achieve what are considered good or excellent outcomes on the modified Rankin Scale (0-1/0-2), yet many are dissatisfied with their outcomes. There is a need for a functional outcome measure tailored for minor stroke that better reflects the spectrum of clinical outcomes within this population. We developed the Canadian Outcome Scale for Minor Stroke (COSMOS) and performed an interrater and intrarater reliability study. COSMOS is a 7-point scale ranging from 0 (no symptoms) to 6 (loss of independence for an instrumental or basic activity of daily living or worse), which accounts for performance limitations and losses of a person's hobbies or passions and of their employment, educational, service, or caregiving pursuits, besides just activities of daily living. One hundred test case vignettes were developed. Stroke physicians, fellows, and research nurses/staff were invited to review training materials and provide the COSMOS grade for 20 cases representing all COSMOS grades (0-6). After a minimum 2 weeks' wash-out period, participants were asked to grade the same 20 cases again. Interrater and intrarater agreement were assessed using Cohen κ, weighted κ, percentage agreement, and intraclass correlation coefficient. Among 33 participants (18 attending physicians, 9 stroke fellows, and 6 research staff/nurses; median 12.5 years of experience), COSMOS had substantial interrater reliability (80.5% agreement [95% CI, 75.7%-85.3%]; Cohen κ, 0.77 [95% CI, 0.72-0.84]) and almost-perfect intrarater reliability overall (87.1% agreement [95% CI, 84.4%-89.7%]; Cohen κ, 0.85 [95% CI, 0.82-0.88]); weighted κ showed almost perfect agreement for both interrater (0.88 [95% CI, 0.85-0.92]) and intrarater reliability (0.92 [95% CI, 0.90-0.94]). The overall chance-adjusted simultaneous intrarater/interrater agreement using intraclass correlation coefficient was 0.95 (95% CI, 0.94-0.97). Results were similar with substantial to almost-perfect agreement when considering key subgroups based on position (attendings, fellows, research nurses/staff) and years of experience. In conclusion, the newly proposed COSMOS scale demonstrated substantial interrater and intrarater reliability. The scale merits further study in cohort studies and clinical trials of minor stroke.

Importance:Accurate and timely confirmation of death by neurologic criteria (DNC) is essential for clinical decision-making and organ-donation processes, yet currently available ancillary tests have suboptimal diagnostic performance or limited validation. Objectives:To determine the diagnostic accuracy, interrater reliability, and safety of brain computed tomography (CT) perfusion and CT angiography as ancillary investigations for DNC. Design, Setting, and Participants:Between April 25, 2017, and March 10, 2021, a prospective, multicenter, blinded diagnostic accuracy cohort study was conducted in 15 adult intensive care units across Canada. Consecutive, critically ill adults (aged ≥18 years) with a Glasgow Coma Scale score of 3 and no confounding factors who were at high risk of DNC were included. Data collection and analysis were performed from April 2021 to July 2024. Exposure:Contrast-enhanced brain CT perfusion with CT angiography reconstructions performed within 2 hours of a blinded, standardized clinical DNC examination. Main Outcomes and Measures:The primary outcomes were the sensitivity and specificity of qualitative and quantitative brainstem CT perfusion for DNC determination, assessed by 2 independent neuroradiologists blinded to clinical findings; the prespecified validation threshold was greater than 98%. Secondary outcomes were the diagnostic accuracy of whole-brain CT perfusion and CT angiography, interrater reliability (Cohen κ), and adverse events associated with imaging. Results:A total of 282 patients (mean [SD] age, 57.8 [15.4] years; 133 [47%] female) completed the study protocol and were included in the primary analysis; 204 (72%) of these were ultimately declared deceased by standardized clinical criteria. Qualitative brainstem CT perfusion showed a sensitivity of 98.5% (95% CI, 95.8%-99.7%) and a specificity of 74.4% (95% CI, 63.2%-83.6%); quantitative brainstem CT perfusion was not diagnostically accurate. Qualitative whole-brain CT perfusion yielded a sensitivity of 93.6% (95% CI, 89.3%-96.6%) and a specificity of 92.3% (95% CI, 84.0%-97.1%). CT angiography sensitivity ranged from 75.5% (95% CI, 69.0%-81.2%) to 87.3% (95% CI, 81.9%-91.5%), and its specificity ranged from 89.7% (95% CI, 80.8%-95.5%) to 91.0% (95% CI, 82.4%-96.3%). Interrater reliability was excellent for all ancillary tests (κ ranged from 0.81 [95% CI, 0.73-0.89] to 0.84 [95% CI, 0.78-0.91]). Fourteen patients (5%) experienced minor, self-limited adverse events; no serious adverse events occurred. Conclusions and Relevance:The observed sensitivity and specificity measures for CT perfusion and CT angiography as an ancillary test for DNC did not meet the prespecified validation threshold of greater than 98%. Clinical examination remains the cornerstone of DNC, and ancillary imaging should be interpreted cautiously within a comprehensive clinical assessment.

Introduction Venous thromboembolism (VTE) is a common complication of traumatic brain injury (TBI) and is associated with increased morbidity and mortality. Low molecular weight heparin (LMWH) is recommended for prophylaxis against VTE after trauma but may increase the risk of progression of intracranial bleeding. Limited evidence exists to guide clinicians regarding the optimal timing of VTE prophylaxis in patients with acute TBI. This randomised controlled trial (RCT) will directly compare the safety and effectiveness of early versus delayed initiation of LMWH in patients with moderate to severe TBI.Methods and analysis The study design is a Bayesian adaptive RCT comparing early (within three calendar days of injury) versus delayed (after study Day 7) VTE prophylaxis with the LMWH, dalteparin. All patients receive sequential compression devices until study Day 8. The co-primary effectiveness outcome is the development of clinically important VTE at study Day 8. The co-primary safety outcome is the development of clinically important intracranial bleeding at study Day 8. Secondary outcomes are mortality and functional outcomes (Glasgow Outcome Scale Extended and EQ-5D) measured at study Days 30 and 180; clinically diagnosed VTE to Day 30 and progression of intracranial bleeding to Day 8.Ethics and dissemination This study has been approved through Clinical Trials Ontario’s streamlined ethics review process (board of record, Sunnybrook Health Sciences Centre) and all participating centres. It is conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and Health Canada regulatory requirements. We anticipate that the trial will achieve wide dissemination through publication in a peer-reviewed medical journal and presentation at international conferences targeting the fields of critical care, trauma and neurosurgery. The results of this trial will help guide clinicians aiming to balance the risks and benefits of early anticoagulant prophylaxis after TBI and will inform guideline development.Trial registration number NCT03559114.

Introduction: Delirium is a common clinical syndrome in the ICU. Despite its high prevalence, very little is understood about the biological pathogenesis of delirium. We observed that many known risk factors for delirium are also factors known to impair cerebral glymphatic clearance. We conducted a retrospective observational brain imaging study to investigate the glymphatic system as potentially implicated in delirium. Methods: We searched provincial imaging and clinical records for Alberta to identify patients with 3T MRI study with 3D-MPRAGE T1- & T2-weighted images acquired during or within 24-hours of an ICU admission. Exclusion criteria included obvious anatomical abnormalities, conditions associated with potential structural abnormalities, or lack of ICDSC data in the clinical records. Anonymized MRI images, ICDSC scores, and basic demographics were obtained for eligible records. Blinded researchers processed MR images using standard technique to calculate white matter (WM), cerebral perivascular space (PVS) volumes, and the PVS-WM ratio. Linear regression was performed on whole-brain data to identify demographic and ICDSC variables that should be explored with parcellated brain data. The Shapiro-Wilk test was used to identify non-parametric data and Wilcoxon rank sum or student t-test was used accordingly. All p-values were 2-sided and considered significant at < 0.05 correcting for multiple comparisons. Results: A total of 67 ICU records met the inclusion criteria. 37 patients met exclusion criteria, leaving 30 patients in the final analysis. ICDSC fluctuation score was identified as the most significant variable in the linear regression analysis and was selected for the parcellated brain analysis. Volume-adjusted PVS size was significantly correlated with ICDSC fluctuation scores in several brain regions. The correlation strength in contiguous brain areas was radially-distributed around the bilateral posterior temporal cortex. Conclusions: We found a significant correlation between fluctuating symptoms — one of the hallmarks of delirium — and WM-adjusted PVS volume. The results support the hypothesis that PVS volume correlates with specific clinical features of delirium. This is the first study to identify a potential role of the glymphatic system in delirium. Further studies are needed.

ABSTRACT Background: Objective, evidence-based neuroprognostication of postarrest patients is crucial to avoid inappropriate withdrawal of life-sustaining therapies or prolonged, invasive, and costly therapies that could perpetuate suffering when there is no chance of an acceptable recovery. Postarrest prognostication guidelines exist; however, guideline adherence and practice variability are unknown. Objective: To investigate Canadian practices and opinions regarding assessment of neurological prognosis in postarrest patients. Methods: An anonymous electronic survey was distributed to physicians who care for adult postarrest patients. Results: Of the 134 physicians who responded to the survey, 63% had no institutional protocols for neuroprognostication. While the use of targeted temperature management did not affect the timing of neuroprognostication, an increasing number of clinical findings suggestive of a poor prognosis affected the timing of when physicians were comfortable concluding patients had a poor prognosis. Variability existed in what factors clinicians’ thought were confounders. Physicians identified bilaterally absent pupillary light reflexes (85%), bilaterally absent corneal reflexes (80%), and status myoclonus (75%) as useful in determining poor prognosis. Computed tomography, magnetic resonance imaging, and spot electroencephalography were the most useful and accessible tests. Somatosensory evoked potentials were useful, but logistically challenging. Serum biomarkers were unavailable at most centers. Most (79%) physicians agreed ≥2 definitive findings on neurologic exam, electrophysiologic tests, neuroimaging, and/or biomarkers are required to determine a poor prognosis with a high degree of certainty. Distress during the process of neuroprognostication was reported by 70% of physicians and 51% request a second opinion from an external expert. Conclusion: Significant variability exists in post-cardiac arrest neuroprognostication practices among Canadian physicians.

Plant exposures leading to systemic or topical toxicity are common presentations seen in the emergency department. While often nonfatal, certain highly toxic plants result in cardiovascular or respiratory failure requiring invasive management. We describe a 65-y-old patient who presented with a refractory ventricular dysrhythmia secondary to an unintentional ingestion of an aconitine-containing plant after incorrect identification. Despite aggressive treatment with vasopressors, intravenous fluids, antiarrhythmics, as well as electrolyte correction and multiple attempted synchronized cardioversions, the patient remained in a refractory dysrhythmia with cardiogenic shock. Venoarterial extracorporeal membrane oxygen (ECMO) therapy was initiated successfully and resulted in rapid resolution of the unstable dysrhythmia. The patient was weaned from ECMO in under 48 h and was discharged without neurological or cardiovascular sequelae. This case highlights management options available to clinicians who encounter toxicity associated with aconitine ingestion. Fatal consequences were averted, and caution is required with the use of plant-identifying applications and resources.

ABSTRACT:Advance care planning (ACP) is a process to understand and communicate one’s wishes, values, and preferences for future medical care. As part of the Choosing Wisely Canada “Time to Talk” initiative, the Canadian Neurological Society (CNS) endorsed the creation of a working group to propose ACP recommendations for patients with neurological illness. A narrative review of primary literature on ACP in neurological and non-neurological illness, medical society guidelines, and publications by patient advocacy groups was conducted. Eight ACP recommendations were deemed relevant and important to Canadian neurology practice and were approved by the CNS Board of Directors. The recommendations are meant to serve as guidance for Canadian neurologists, to stimulate discussion about ACP within the Canadian neurology community, and to encourage neurologists to engage in ACP conversations with their patients.

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.

Purpose Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs. Methods We created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements: 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies. Results Through discussion, participants identified three areas for improvement: 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews). Conclusions Existing guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.

Patients with premorbid disability or dementia have generally been excluded from randomized controlled trials of reperfusion therapies such as thrombolysis and endovascular therapy for acute ischemic stroke. Consequently, stroke physicians face treatment dilemmas in caring for such patients. In this scientific statement, we review the literature on acute ischemic stroke in patients with premorbid disability or dementia and propose principles to guide clinicians, clinician-scientists, and policymakers on the use of acute stroke therapies in these populations. Recent clinical-epidemiological studies have demonstrated challenges in our concept and measurement of premorbid disability or dementia while highlighting the significant proportion of the general stroke population that falls under this umbrella, risking exclusion from therapies. Such studies have also helped clarify the adverse long-term clinical and health economic consequences with each increment of additional poststroke disability in these patients, underscoring the importance of finding strategies to mitigate such additional disability. Several observational studies, both case series and registry-based studies, have helped demonstrate the comparable safety of endovascular therapy in patients with premorbid disability or dementia and in those without, complementing similar data on thrombolysis. These data also suggest that such patients have a substantial potential to retain their prestroke level of disability when treated, despite their generally worse prognosis overall, although this remains to be validated in higher-quality registries and clinical trials. By pairing pragmatic and transparent decision-making in clinical practice with an active pursuit of high-quality research, we can work toward a more inclusive paradigm of patient-centered care for this often-neglected patient population.

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Traumatic brain injury (TBI) is common and potentially devastating. Traditional examination-based patient monitoring following TBI may be inadequate for frontline clinicians to reduce secondary brain injury through individualized therapy. Multimodal neurologic monitoring (MMM) offers great potential for detecting early injury and improving outcomes. By assessing cerebral oxygenation, autoregulation and metabolism, clinicians may be able to understand neurophysiology during acute brain injury, and offer therapies better suited to each patient and each stage of injury. Hence, we offer this primer on brain tissue oxygen monitoring, pressure reactivity index monitoring and cerebral microdialysis. This narrative review serves as an introductory guide to the latest clinically-relevant evidence regarding key neuromonitoring techniques.

ABSTRACT: Background: Most patients with World Federation of Neurological Surgeons (WFNS) grade 5 subarachnoid hemorrhage (SAH) have poor outcomes. Accurate assessment of prognosis is important for treatment decisions and conversations with families regarding goals of care. Unjustified pessimism may lead to “self-fulfilling prophecy,” where withdrawal of life-sustaining measures (WLSM) is invariably followed by death. Methods: We performed a cohort study involving consecutive patients with WFNS grade 5 SAH to identify variables with >= 90% and >= 95% positive predictive value (PPV) for poor outcome (1-year modified Rankin Score >= 4), as well as findings predictive of WLSM. Results: Of 140 patients, 38 (27%) had favorable outcomes. Predictors with >= 95% PPV for poor outcome included unconfounded 72-hour Glasgow Coma Scale motor score <= 4, absence of >= 1 pupillary light reflex (PLR) at 24 hours, and intraventricular hemorrhage (IVH) score of >= 20 (volume >= 54.6 ml). Intracerebral hemorrhage (ICH) volume >= 53 ml had PPV of 92%. Variables associated with WLSM decisions included a poor motor score (p < 0.0001) and radiographic evidence of infarction (p = 0.02). Conclusions: We identified several early predictors with high PPV for poor outcome. Of these, lack of improvement in motor score during the initial 72 hours had the greatest potential for confounding from “self-fulfilling prophecy.” Absence of PLR at 24 hours, IVH score >= 20, and ICH volume >= 53 ml predicted poor outcome without a statistically significant effect on WLSM decisions. More research is needed to validate prognostic variables in grade 5 SAH, especially among patients who do not undergo WLSM.

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.