Background: Prevalence of upper limb weakness early post-stroke has declined by ~30% over 30 years. Introduction of acute stroke interventions into routine care is one possible explanation for this observation.
Aim: To describe the upper limb weakness profile within the first 48-hours post-stroke based on the interaction between stroke severity and acute medical intervention on a comprehensive statewide stroke unit.
Methods: Observational study using routinely collected data over 20-months from the electronic medical record: admission National Institutes of Health Stroke Scale (NIHSS; stroke severity: mild <5, moderate 5-14, severe >15), day 1 Shoulder Abduction and Finger Extension (SAFE) score (weakness: severe 0-4, moderate 5-8 and little-to-none 9-10), and provision of acute intervention(s) (e.g., thrombolysis).
Results: There were 837 confirmed stroke patients with a reported NIHSS and SAFE score. Mild (35.5%) and moderately (37.9%) severe strokes were evenly spread, with fewer severe strokes presenting (26.9%). Provision of acute medical intervention was highest in those with severe stroke (70.2% severe vs 55.6% moderate vs 20.5% mild). The distribution of weakness (median 1-day post-stroke) based on intervention provision varied most for those with a severe stroke:
- Intervention; severe 48.1%, moderate 28.8%, little-to-none 23.1% upper-limb weakness
- No intervention; severe 78.8%, moderate 13.6%, little-to-none 7.6% upper-limb weakness
Conclusion: The varied distribution of upper limb weakness when acute medical interventions are delivered highlights the importance of looking across the continuum of care to understand potential mediators of recovery. Understanding these profiles also has implications for eligibility criteria development and clinical trial site selection.