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Abstract Details

Clinical And Imaging Factors Associated With The Use Of Comfort Measures Only in Acute Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
117
To evaluate clinical and imaging factors associated with the use of comfort measures only (CMO) in patients with acute ischemic stroke (AIS). 
Up to 10% of AIS can die in first 30 days. Older age and higher National Institutes of Health stroke scale (NIHSS) are associated with transition to CMO. There is insufficient data on association of specific etiology, vascular territory or anatomical structure involved with the use of CMO in AIS.
We did a retrospective study of AIS admitted between 7/1/15 to 6/30/2016. Patients were divided in 2 groups based on the use of CMO orders. Clinical, laboratory and imaging data were obtained. Multivariate analysis was performed adjusting for pertinent demographics, clinical, laboratory and imaging characteristics. 
Of 296 patients in the study, 27 (9%) patients were transitioned to CMO. Compared to patients without CMO, patients with CMO were older (mean 75 vs 66 years, p=0.002), had more coronary artery disease (37% vs 19%,p=0.04), higher NIHSS score (median 21 vs 5, p=<0.0001); more anterior cerebral artery (37% vs 7%, p=<0.0001), M1 segment middle cerebral artery (81% vs 24%,p=<0.0001), and multiple vascular territories stroke (33% vs 14%, p=0.02); more cardioembolic (46% vs 25%) and less small vessel disease stroke (0% vs 23%, p=0.02). Patients with CMO were more likely to have infarction of insula (93% vs 30%, p<0.0001), frontal (93% vs 57%, p=0.0001), parietal (81% vs 38%, p<0.0001) and temporal lobe (89% vs 33%, p<0.0001). On multivariate analysis NIHSS score (OR=1.2; 95% CI=1.1-1.5; p=0.0002), tobacco use (OR=4.7; 95% CI=1.1-20.0; p=0.03), infarction of insular cortex (OR=40.3; 95% CI=2.2-726.0; p=0.01), and cerebral edema and herniation (OR=22.2; 95% CI=4.1-119.4; p=0.0003) were associated with transition to CMO in AIS. 
Infarction of the insular cortex was predictive of use of CMO in AIS. Larger studies are needed to confirm our findings. 
Authors/Disclosures
Varun Jain, MD, MBBS
PRESENTER 		Dr. Jain has nothing to disclose.
Amreen Farooqui, MD (University of Florida, Department of Neurology) Dr. Farooqui has nothing to disclose.
Nandakumar Nagaraja, MD (Penn State Health Milton S. Hershey Medical Center) The institution of Dr. Nagaraja has received research support from 1 Florida Alzheimer's Disease Research Center. Dr. Nagaraja has received personal compensation in the range of $500-$4,999 for serving as a stroke outcome adjudicator for WHI study with Fred Hutchinson Cancer Research Center.