DanielStrbian, Helsinki University Central Hospitaldaniel.strbian@hus.fi
Markku Kaste, Helsinki, Finland; Turgut Tatlisumak, Helsinki, Finland
Submitted April 02, 2012
Although we disagree with their opinion, we thank our Drs. Bruno and Switzer for allowing us to further clarify some points. In an emergency room, it is easy to estimate whether a stroke patient has been totally independent prior to his/her index stroke (i.e., whether his/her pre-stroke mRS is 0-1). It only takes one face-to- face or over-the-phone question to a family member. In addition, the patient probably has a recent hospital record. A stroke physician would not give thrombolysis treatment to a patient who required constant help in his/her ADL activities prior to index stroke.
It is also much faster and easier to evaluate pre-stroke mRS than pre-stroke Barthel Index. Scoring pre-stroke Barthel Index by reviewing all the steps either face-to- face or over-the-phone is more time consuming, especially when considering that "time is brain." In our experience, detailed information needed for Barthel Index is rarely found in the patients' hospital records.
The SEDAN score, [1] which evaluates the risk of symptomatic intracranial hemorrhage following thrombolysis, together with the DRAGON score can assist in the estimation of the risks and benefits of thrombolysis.
1. Strbian D, Engelter S, Michel P, et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN Score (in press Ann Neurol).
For disclosures, contact the editorial office at jorunal@neurology.org.
Although we disagree with their opinion, we thank our Drs. Bruno and Switzer for allowing us to further clarify some points. In an emergency room, it is easy to estimate whether a stroke patient has been totally independent prior to his/her index stroke (i.e., whether his/her pre-stroke mRS is 0-1). It only takes one face-to- face or over-the-phone question to a family member. In addition, the patient probably has a recent hospital record. A stroke physician would not give thrombolysis treatment to a patient who required constant help in his/her ADL activities prior to index stroke.
It is also much faster and easier to evaluate pre-stroke mRS than pre-stroke Barthel Index. Scoring pre-stroke Barthel Index by reviewing all the steps either face-to- face or over-the-phone is more time consuming, especially when considering that "time is brain." In our experience, detailed information needed for Barthel Index is rarely found in the patients' hospital records.
The SEDAN score, [1] which evaluates the risk of symptomatic intracranial hemorrhage following thrombolysis, together with the DRAGON score can assist in the estimation of the risks and benefits of thrombolysis.
1. Strbian D, Engelter S, Michel P, et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN Score (in press Ann Neurol).
For disclosures, contact the editorial office at jorunal@neurology.org.