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Objectives Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach. Materials and Methods Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique. Time delays, sample quality, and logistics were investigated between May 20, 2013 and May 19, 2014. Results Prehospital blood sampling and study recruiting were successfully performed for 430 thrombolysis candidates, of which 50% had ischemic stroke, 14.4% TIA, 13.5% hemorrhagic stroke, and 22.1% stroke mimics. A total of 66.3% of all samples were collected during non-office hours. The median (interquartile range) emergency call to prehospital sample time was 33 minutes (25-41), and the median time from reported symptom onset or wake-up to prehospital sample was 53 minutes (38-85; n=394). Prehospital sampling was performed 31 minutes (25-42) earlier than hospital admission blood sampling and 37 minutes (30-47) earlier than admission neuroimaging. Hemolysis rate in serum and plasma samples was 6.5% and 9.3% for EMS samples, and 0.7% and 1.6% for admission samples. Conclusions Prehospital biomarker sampling can be implemented in all EMS units and provides a median timesaving of more than 30 minutes to first blood sample. Large prehospital sample sets will enable development of novel ambulance biomarkers to improve early differential diagnosis and treatment of thrombolysis candidates. [ABSTRACT FROM AUTHOR]

Background and purpose Proteinuria and estimated glomerular filtration rate ( eGFR) are indicators of renal function. Whether proteinuria better predicts outcome than eGFR in stroke patients treated with intravenous thrombolysis ( IVT) remains to be determined. Methods In this explorative multicenter IVT register based study, the presence of urine dipstick proteinuria (yes/no), reduced eGFR (<60 ml/min/1.73 m2) and the coexistence of both with regard to (i) poor 3-month outcome (modified Rankin Scale score 3-6), (ii) death within 3 months and (iii) symptomatic intracranial hemorrhage ( ECASS- II criteria) were compared. Unadjusted and adjusted odds ratios ( ORs) with 95% confidence intervals were calculated. Results Amongst 3398 patients, 881 (26.1%) had proteinuria and 623 (18.3%) reduced eGFR. Proteinuria [ ORadjusted 1.65 (1.37-2.00) and ORadjusted 1.52 (1.24-1.88)] and reduced eGFR [ ORadjusted 1.26 (1.01-1.57) and ORadjusted 1.34 (1.06-1.69)] were independently associated with poor functional outcome and death, respectively. After adding both renal markers to the models, proteinuria [ ORadjusted+eGFR 1.59 (1.31-1.93)] still predicted poor outcome whilst reduced eGFR [ ORadjusted+proteinuria 1.20 (0.96-1.50)] did not. Proteinuria was associated with symptomatic intracranial hemorrhage [ ORadjusted 1.54 (1.09-2.17)] but not reduced eGFR [ ORadjusted 0.96 (0.63-1.62)]. In 234 (6.9%) patients, proteinuria and reduced eGFR were coexistent. Such patients were at the highest risk of poor outcome [ ORadjusted 2.16 (1.54-3.03)] and death [ ORadjusted 2.55 (1.69-3.84)]. Conclusion Proteinuria and reduced eGFR were each independently associated with poor outcome and death but the statistically strongest association appeared for proteinuria. Patients with coexistent proteinuria and reduced eGFR were at the highest risk of poor outcome and death. [ABSTRACT FROM AUTHOR]

Objectives Better identification and triage of acute posterior circulation ( PC) stroke patients is needed as the PC ischemic stroke ( IS) patients may be allowed longer thrombolysis window than anterior circulation ( AC) IS patients and PC patients with hemorrhagic stroke ( ICH) may require care in a neurosurgical unit possibly remote from stroke unit. Materials and methods Consecutive stroke patients treated at a tertiary center with thrombolysis (100% for IS) and/or comprehensive stroke unit care. Results Altogether, 1641 patients had AC (75%) and 553 PC strokes. The PC- IS patients were younger (65 vs 70), had less often prior hypertension (51 vs 61%), and were twice more often on warfarin. They presented 3.5 times more often with seizure, vomited five times more often, had headache twice as often, and required intubation 2 to 3 times more often despite equal NIHSS (9 vs 8) or GCS (15 both) scores with AC- IS patients. Among PC patients, IS (n = 190) associated with younger age, prior atrial fibrillation ( AF) in 25% and dyslipidemia in ~40%. One-third of PC- ICH patients (n = 363) had headache and vomited at the onset. PC- ICH patients had BP median of 177/92 mmHg and blood glucose 7.4 mmol/l on ER arrival. Warfarin use was twice as common in PC- ICH. Conclusions Despite being of typical age for multiple cardiovascular conditions the PC- ICH patients less often have a previous history of AF or dyslipidemia than IS patients do. The vomiting PC- ICH patient with hypertensive BP values often has headache and a red flag for hemorrhage is warfarin treatment. [ABSTRACT FROM AUTHOR]