Department of General Emergency, Clínica Alemana de Santiago, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Stroke Vasc Neurol. 2020 Dec;5(4):406-409. doi: 10.1136/svn-2020-000387. Epub 2020 Jun 25.
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.
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.
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).
Early FP had no significant effect in patients with moderate-severe AIS.
NCT02162017.
尽管急性卒中头位试验（HeadPoST）表明，在急性缺血性卒中（AIS）患者中，仰卧位（FP）与坐立位（SUP）对头位的摆放对功能结局无影响，但我们假设，如果在 AIS 发病后 4.5 小时内开始使用 FP，对于至少中度严重程度的 AIS 患者，仍然可能会带来获益。
HeadPoST 研究的亚组分析，纳入 NIHSS 评分≥7、≥10 和≥14 的患者，在 AIS 发病 4.5 小时内随机分配到 FP 或 SUP 组，主要结局为改良 Rankin 量表（mRS）评分的变化和死亡/残疾（mRS 评分 3-6），次要结局为任何心血管不良事件。使用逻辑回归分析，调整了研究设计和基线风险因素。
在按基线 NIHSS 评分递增的患者亚组中，没有观察到治疗效果的显著差异：调整后的 OR 和 95%CI 对于 mRS 评分的有序变化和二进制（3-6）mRS 评分的变化：对于 NIHSS≥7（n=867），0.92（0.67 至 1.25）和 0.74（0.52 至 1.04）；对于 NIHSS≥10（n=606），0.80（0.58 至 1.10）和 0.77（0.49 至 1.19）；对于 NIHSS≥14（n=378），0.82（0.54 至 1.24）和 1.22（0.69 至 2.14）。
早期 FP 对中重度 AIS 患者没有显著影响。
NCT02162017。
