Cluster-randomized, crossover trial of head positioning in acute stroke
Author
dc.contributor.author
Anderson, C. S.
Author
dc.contributor.author
Arima, H.
Author
dc.contributor.author
Lavados Germain, Pablo Manuel
Author
dc.contributor.author
Billot, L.
Author
dc.contributor.author
Hackett, M. L.
Author
dc.contributor.author
Olavarría, V. V.
Author
dc.contributor.author
Muñoz Venturelli, Paula
Author
dc.contributor.author
Brunser, A.
Author
dc.contributor.author
Peng, B.
Author
dc.contributor.author
Cui, L.
Author
dc.contributor.author
Song, L.
Author
dc.contributor.author
Rogers, K.
Author
dc.contributor.author
Middleton, S.
Author
dc.contributor.author
Lim, J. Y.
Author
dc.contributor.author
Forshaw, D.
Author
dc.contributor.author
Lightbody, C. E.
Author
dc.contributor.author
Woodward, M.
Author
dc.contributor.author
Pontes‑Neto, O.
Author
dc.contributor.author
Silva, H. A. De
Author
dc.contributor.author
Lin, R. -T
Author
dc.contributor.author
Lee, T.-H
Author
dc.contributor.author
Pandian, J. D.
Author
dc.contributor.author
Mead, G. E.
Author
dc.contributor.author
Robinson, T.
Author
dc.contributor.author
Watkins, C.
Admission date
dc.date.accessioned
2018-04-19T13:20:39Z
Available date
dc.date.available
2018-04-19T13:20:39Z
Publication date
dc.date.issued
2017
Cita de ítem
dc.identifier.citation
N Engl J Med 2017;376:2437-47.
es_ES
Identifier
dc.identifier.other
10.1056/NEJMoa1615715
Identifier
dc.identifier.uri
https://repositorio.uchile.cl/handle/2250/147319
Abstract
dc.description.abstract
BACKGROUND
The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion.
METHODS
In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death).
RESULTS
The median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P<0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P = 0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P = 0.83). There were no significant between-group differences in the rates of serious adverse events, including pneumonia.
CONCLUSIONS
Disability outcomes after acute stroke did not differ significantly between patients assigned to a lying-flat position for 24 hours and patients assigned to a sitting-up position with the head elevated to at least 30 degrees for 24 hours. (Funded by the National Health and Medical Research Council of Australia; HeadPoST ClinicalTrials.gov number, NCT02162017.)
es_ES
Patrocinador
dc.description.sponsorship
National Health and Medical Research Council of Australia