Pre-hospital Transdermal Glyceryl Trinitrate in Patients With Stroke Mimics: Data From the RIGHT-2 Randomised-Controlled Ambulance Trial

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aut.relation.articlenumber2en_NZ
aut.relation.issue1en_NZ
aut.relation.journalBMC Emergency Medicineen_NZ
aut.relation.volume22en_NZ
aut.researcherTunnage, Bronwyn
dc.contributor.authorTunnage, Ben_NZ
dc.contributor.authorWoodhouse, LJen_NZ
dc.contributor.authorDixon, Men_NZ
dc.contributor.authorAnderson, Cen_NZ
dc.contributor.authorAnkolekar, Sen_NZ
dc.contributor.authorAppleton, Jen_NZ
dc.contributor.authorCala, Len_NZ
dc.contributor.authorEngland, Ten_NZ
dc.contributor.authorKrishnan, Ken_NZ
dc.contributor.authorHavard, Den_NZ
dc.contributor.authorMair, Gen_NZ
dc.contributor.authorMuir, Ken_NZ
dc.contributor.authorPhillips, Sen_NZ
dc.contributor.authorPotter, Jen_NZ
dc.contributor.authorPrice, Cen_NZ
dc.contributor.authorRandall, Men_NZ
dc.contributor.authorRobinson, TGen_NZ
dc.contributor.authorRoffe, Cen_NZ
dc.contributor.authorSandset, Een_NZ
dc.contributor.authorSiriwardena, Nen_NZ
dc.contributor.authorScutt, Pen_NZ
dc.contributor.authorWardlaw, JMen_NZ
dc.contributor.authorSprigg, Nen_NZ
dc.contributor.authorBath, PMen_NZ
dc.date.accessioned2022-03-03T21:26:44Z
dc.date.available2022-03-03T21:26:44Z
dc.date.copyright2022-12en_NZ
dc.date.issued2022-12en_NZ
dc.description.abstractBackground Prehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2). Methods RIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days. Results Among 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event. Conclusions One-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm.en_NZ
dc.identifier.citationBMC Emergency Medicine 22, 2 (2022). https://doi.org/10.1186/s12873-021-00560-x
dc.identifier.doi10.1186/s12873-021-00560-xen_NZ
dc.identifier.issn1471-227Xen_NZ
dc.identifier.urihttps://hdl.handle.net/10292/14972
dc.languageenen_NZ
dc.publisherSpringer Science and Business Media LLCen_NZ
dc.relation.urihttps://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00560-x
dc.rights© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectStroke; Mimic; Functional stroke; Migraine; Seizures; Glyceryl trinitrate; Nitroglycerin; Ambulance; Paramedic
dc.titlePre-hospital Transdermal Glyceryl Trinitrate in Patients With Stroke Mimics: Data From the RIGHT-2 Randomised-Controlled Ambulance Trialen_NZ
dc.typeJournal Article
pubs.elements-id447386
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Faculty of Health & Environmental Science
pubs.organisational-data/AUT/Faculty of Health & Environmental Science/School of Clinical Sciences
pubs.organisational-data/AUT/PBRF
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HH Clinical Sciences 2018 PBRF
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