Midline Shift Greater than 3 mm Independently Predicts Outcome After Ischemic Stroke

Morgan E. McKeown, Ayush Prasad, Jessica Kobsa, Ilayda Top, Samuel B. Snider, Chelsea Kidwell, Bruce C.V. Campbell, Stephen M. Davis, Geoffrey A. Donnan, Michael Lev, Kevin N. Sheth, Nils Petersen, W. Taylor Kimberly, Matthew B. Bevers

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Cerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acute stroke. Methods: Patient-level data from six acute stroke clinical trials were combined with endovascular thrombectomy registries from two academic referral centers, generating a combined cohort of 1977 patients. MLS was extracted from the original trial data or measured on computed tomography or magnetic resonance imaging that was obtained a median of 47.0 h (interquartile range 27.0–75.1 h) after stroke onset. Logistic regression was performed to identify predictors of poor outcome and the minimal clinically relevant MLS threshold. Results: The presence of MLS was a predictor of poor outcome, independent of baseline clinical and demographic factors (adjusted odds ratio 4.46, 95% confidence interval 3.56–5.59, p < 0.001). Examining the full range of MLS values identified, a value of greater than 3 mm was the critical threshold that significantly predicted poor outcome (adjusted odds ratio 3.20 [1.31–7.82], p = 0.011). Conclusions: These results show that the presence of MLS predicts poor outcome and, specifically, MLS value greater than 3 mm is an important threshold across a variety of clinical settings. These findings may have relevance for the design and interpretation of future trials for antiedema therapies.

Original languageEnglish (US)
Pages (from-to)46-51
Number of pages6
JournalNeurocritical Care
Volume36
Issue number1
DOIs
StatePublished - Feb 2022

Keywords

  • Brain edema
  • Ischemic stroke
  • Neuroimaging

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

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