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A prospective study of wake-up stroke patients presenting to the emergency department: a single-center cohort study

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Abstract

Introduction

This study aims to prospectively examine patients with ischemic wake-up stroke (WUS) presenting to the emergency department, to investigate the risk factors affecting the mortality occurring within 28, 90, and 180 days, and to create a new scoring system for the prediction of 28-day mortality.

Materials and method

Patients who presented to the emergency department with WUS findings between 01.07.2019 and 30.06.2020 were prospectively analyzed. Logistic regression analysis was performed to determine the factors affecting mortality and the modified Rankin scale (mRS).

Results

A total of 161 patients were included. Of the patients, 22.4% died within 28 days and 40.4% within 180 days. The presence of coronary artery disease (CAD) increased the 28-day mortality risk (p = 0.009) 3.57 times, 90-day mortality risk 2.15 times (p = 0.033), and 180-day mortality risk 2.18 times (p = 0.045). In order to be used in the prediction of 28-day mortality in patients with WUS, we developed the ischemic WUS mortality score (IWUSMOS), which consists of the middle cerebral artery (45 points), internal carotid artery (60 points), basilar artery (39 points), superior cerebellar artery (66 points) occlusion, hypertension (33 points), CAD (28 points), malignancy (100 points), and arrhythmia (23 points). With this scoring system, the 28-day mortality risk was determined as 0.05% when the total score was “43” whereas the mortality risk was found to be 95.0% when the total score was “187.”

Conclusion

We propose that IWUSMOS, a new scoring system, can be used to predict the 28-day mortality risk of patients with WUS.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey

    Melih Yüksel, Halil Kaya, Mehmet Oğuzhan Ay, Aksel Özdemir, Fatma Betül Çalışkan & Funda Yılmaz

  2. Department of Neurology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey

    Demet Yıldız

  3. Department of Biostatistics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey

    Deniz Sığırlı

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  1. Melih Yüksel
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  2. Halil Kaya
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  7. Fatma Betül Çalışkan
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Correspondence to Melih Yüksel.

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Ethics approval and consent to participate

This study was carried out at the University of Health Sciences Turkey, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Emergency Medicine, with the approval of the clinical research ethics committee of the same hospital with the protocol number 2011-KAEK-25–2019/06–13. All patients in the study have provided consent and patient anonymity has been preserved.

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The authors declare no competing interests.

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Yüksel, M., Kaya, H., Ay, M.O. et al. A prospective study of wake-up stroke patients presenting to the emergency department: a single-center cohort study. Ir J Med Sci 192, 409–416 (2023). https://doi.org/10.1007/s11845-022-02995-y

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  • DOI: https://doi.org/10.1007/s11845-022-02995-y

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