Skip to main content
Top
Published in: BMC Neurology 1/2014

Open Access 01-12-2014 | Research article

Lessons from everyday stroke care for clinical research and vice versa: comparison of a comprehensive and a research population of young stroke patients

Authors: Christian Tanislav, Ulrike Grittner, Bjoern Misselwitz, Gerhard Jan Jungehuelsing, Christian Enzinger, Bettina von Sarnowski, Jukka Putaala, Manfred Kaps, Peter Kropp, Arndt Rolfs, Turgut Tatlisumak, Franz Fazekas, Edwin Kolodny, Bo Norrving

Published in: BMC Neurology | Issue 1/2014

Login to get access

Abstract

Background

Translating knowledge derived from medical research into the clinical setting is dependent on the representativeness of included patients. Therefore we compared baseline data of patients included in a recent large study addressing young stroke in comparison to a large representative stroke registry.

Methods

We analysed baseline data of 5023 patients (age 18-55 years) with an acute cerebrovascular event included in the sifap1 (Stroke in Young Fabry Patients) study. For comparison 17007 stroke patients (age 18-55 years) documented (2004-2010) in a statutory stroke registry of the Institute of Quality Assurance Hesse of the Federal State of Hesse (GQH), Germany.

Results

Among 17007 juvenile (18-55 years) patients identified in the GQH registry 15997 had an ischaemic stroke or TIA (91%) or an intracranial haemorrhage (9%). In sifap1 5023 subjects were included. Sex distribution was comparable (men: 59% sifap1 versus 60.5% GQH) whereas age differed between the groups: median age was 46 years in sifap1 versus 49 years in GQH. Slightly higher percentages for diabetes mellitus and hypertension in the GQH registry were noted. There were no differences in stroke severity as assessed by NIHSS (median 3) and mRS (median 2). In patients with ischaemic stroke or TIA (n = 4467 sifap1; n = 14522 GQH) higher rates of strokes due to small artery occlusion and atherosclerosis occurred in older age groups; cardioembolism and strokes of other determined cause occurred more frequently in younger patients.

Conclusions

The comparison of baseline characteristics between the sifap1 study and the GQH registry revealed differences mainly determined by age.
Appendix
Available only for authorised users
Literature
1.
2.
go back to reference Rolfs A, Fazekas F, Grittner U, Dichgans M, Martus P, Holzhausen M, Bottcher T, Heuschmann PU, Tatlisumak T, Tanislav C, Jungehulsing GJ, Giese AK, Putaala J, Huber R, Bodechtel U, Lichy C, Enzinger C, Schmidt R, Hennerici MG, Kaps M, Kessler C, Lackner K, Paschke E, Meyer W, Mascher H, Riess O, Kolodny E, Norrving B: Acute cerebrovascular disease in the young: the Stroke in Young Fabry Patients study. Stroke. 2013, 44: 340-349. 10.1161/STROKEAHA.112.663708.CrossRefPubMed Rolfs A, Fazekas F, Grittner U, Dichgans M, Martus P, Holzhausen M, Bottcher T, Heuschmann PU, Tatlisumak T, Tanislav C, Jungehulsing GJ, Giese AK, Putaala J, Huber R, Bodechtel U, Lichy C, Enzinger C, Schmidt R, Hennerici MG, Kaps M, Kessler C, Lackner K, Paschke E, Meyer W, Mascher H, Riess O, Kolodny E, Norrving B: Acute cerebrovascular disease in the young: the Stroke in Young Fabry Patients study. Stroke. 2013, 44: 340-349. 10.1161/STROKEAHA.112.663708.CrossRefPubMed
3.
go back to reference Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T: Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009, 40: 1195-1203. 10.1161/STROKEAHA.108.529883.CrossRefPubMed Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T: Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009, 40: 1195-1203. 10.1161/STROKEAHA.108.529883.CrossRefPubMed
4.
go back to reference Yesilot Barlas N, Putaala J, Waje-Andreassen U, Vassilopoulou S, Nardi K, Odier C, Hofgart G, Engelter S, Burow A, Mihalka L, Kloss M, Ferrari J, Lemmens R, Coban O, Haapaniemi E, Maaijwee N, Rutten-Jacobs L, Bersano A, Cereda C, Baron P, Borellini L, Valcarenghi C, Thomassen L, Grau AJ, Palm F, Urbanek C, Tuncay R, Durukan TA, van Dijk EJ, de Leeuw FE, et al: Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013, 20: 1431-1439.PubMed Yesilot Barlas N, Putaala J, Waje-Andreassen U, Vassilopoulou S, Nardi K, Odier C, Hofgart G, Engelter S, Burow A, Mihalka L, Kloss M, Ferrari J, Lemmens R, Coban O, Haapaniemi E, Maaijwee N, Rutten-Jacobs L, Bersano A, Cereda C, Baron P, Borellini L, Valcarenghi C, Thomassen L, Grau AJ, Palm F, Urbanek C, Tuncay R, Durukan TA, van Dijk EJ, de Leeuw FE, et al: Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013, 20: 1431-1439.PubMed
5.
go back to reference Bhalla A, Grieve R, Rudd AG, Wolfe CD: Stroke in the young: access to care and outcome; a Western versus eastern European perspective. J Stroke Cerebrovasc Dis. 2008, 17: 360-365. 10.1016/j.jstrokecerebrovasdis.2008.04.002.CrossRefPubMed Bhalla A, Grieve R, Rudd AG, Wolfe CD: Stroke in the young: access to care and outcome; a Western versus eastern European perspective. J Stroke Cerebrovasc Dis. 2008, 17: 360-365. 10.1016/j.jstrokecerebrovasdis.2008.04.002.CrossRefPubMed
6.
go back to reference Varona JF, Bermejo F, Guerra JM, Molina JA: Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol. 2004, 251: 1507-1514. 10.1007/s00415-004-0583-0.CrossRefPubMed Varona JF, Bermejo F, Guerra JM, Molina JA: Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol. 2004, 251: 1507-1514. 10.1007/s00415-004-0583-0.CrossRefPubMed
7.
go back to reference Rolfs A, Martus P, Heuschmann PU, Grittner U, Holzhausen M, Tatlisumak T, Bottcher T, Fazekas F, Enzinger C, Ropele S, Schmidt R, Riess O, Norrving B: Protocol and methodology of the Stroke in Young Fabry Patients (sifap1) study: a prospective multicenter European study of 5,024 young stroke patients aged 18-55 years. Cerebrovasc Dis. 2011, 31: 253-262. 10.1159/000322153.CrossRefPubMed Rolfs A, Martus P, Heuschmann PU, Grittner U, Holzhausen M, Tatlisumak T, Bottcher T, Fazekas F, Enzinger C, Ropele S, Schmidt R, Riess O, Norrving B: Protocol and methodology of the Stroke in Young Fabry Patients (sifap1) study: a prospective multicenter European study of 5,024 young stroke patients aged 18-55 years. Cerebrovasc Dis. 2011, 31: 253-262. 10.1159/000322153.CrossRefPubMed
8.
go back to reference Foerch C, Misselwitz B, Sitzer M, Berger K, Steinmetz H, Neumann-Haefelin T: Difference in recognition of right and left hemispheric stroke. Lancet. 2005, 366: 392-393. 10.1016/S0140-6736(05)67024-9.CrossRefPubMed Foerch C, Misselwitz B, Sitzer M, Berger K, Steinmetz H, Neumann-Haefelin T: Difference in recognition of right and left hemispheric stroke. Lancet. 2005, 366: 392-393. 10.1016/S0140-6736(05)67024-9.CrossRefPubMed
9.
go back to reference Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993, 24: 35-41. 10.1161/01.STR.24.1.35.CrossRefPubMed Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993, 24: 35-41. 10.1161/01.STR.24.1.35.CrossRefPubMed
10.
go back to reference Stolz E, Hamann GF, Kaps M, Misselwitz B: Regional differences in acute stroke admission and thrombolysis rates in the German federal state of Hesse. Dtsch Arztebl Int. 2011, 108: 607-611.PubMedPubMedCentral Stolz E, Hamann GF, Kaps M, Misselwitz B: Regional differences in acute stroke admission and thrombolysis rates in the German federal state of Hesse. Dtsch Arztebl Int. 2011, 108: 607-611.PubMedPubMedCentral
11.
go back to reference Jauss M, Schutz HJ, Tanislav C, Misselwitz B, Rosenow F: Effect of daytime, weekday and year of admission on outcome in acute ischaemic stroke patients treated with thrombolytic therapy. Eur J Neurol. 2010, 17: 555-561. 10.1111/j.1468-1331.2009.02845.x.CrossRefPubMed Jauss M, Schutz HJ, Tanislav C, Misselwitz B, Rosenow F: Effect of daytime, weekday and year of admission on outcome in acute ischaemic stroke patients treated with thrombolytic therapy. Eur J Neurol. 2010, 17: 555-561. 10.1111/j.1468-1331.2009.02845.x.CrossRefPubMed
12.
go back to reference Varona JF, Guerra JM, Bermejo F, Molina JA, de la Gomez CA: Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol. 2007, 57 (4): 212-218. 10.1159/000099161.CrossRefPubMed Varona JF, Guerra JM, Bermejo F, Molina JA, de la Gomez CA: Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol. 2007, 57 (4): 212-218. 10.1159/000099161.CrossRefPubMed
13.
go back to reference von Sarnowski B, Putaala J, Grittner U, Gaertner B, Schminke U, Curtze S, Huber R, Tanislav C, Lichy C, Demarin V, Basic-Kes V, Ringelstein EB, Neumann-Haefelin T, Enzinger C, Fazekas F, Rothwell PM, Dichgans M, Jungehulsing GJ, Heuschmann PU, Kaps M, Norrving B, Rolfs A, Kessler C, Tatlisumak T: Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study. Stroke. 2013, 44: 119-125. 10.1161/STROKEAHA.112.665190.CrossRefPubMed von Sarnowski B, Putaala J, Grittner U, Gaertner B, Schminke U, Curtze S, Huber R, Tanislav C, Lichy C, Demarin V, Basic-Kes V, Ringelstein EB, Neumann-Haefelin T, Enzinger C, Fazekas F, Rothwell PM, Dichgans M, Jungehulsing GJ, Heuschmann PU, Kaps M, Norrving B, Rolfs A, Kessler C, Tatlisumak T: Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study. Stroke. 2013, 44: 119-125. 10.1161/STROKEAHA.112.665190.CrossRefPubMed
14.
go back to reference Rolfs A, Bottcher T, Zschiesche M, Morris P, Winchester B, Bauer P, Walter U, Mix E, Lohr M, Harzer K, Strauss U, Pahnke J, Grossmann A, Benecke R: Prevalence of Fabry disease in patients with cryptogenic stroke: a prospective study. Lancet. 2005, 366: 1794-1796. 10.1016/S0140-6736(05)67635-0.CrossRefPubMed Rolfs A, Bottcher T, Zschiesche M, Morris P, Winchester B, Bauer P, Walter U, Mix E, Lohr M, Harzer K, Strauss U, Pahnke J, Grossmann A, Benecke R: Prevalence of Fabry disease in patients with cryptogenic stroke: a prospective study. Lancet. 2005, 366: 1794-1796. 10.1016/S0140-6736(05)67635-0.CrossRefPubMed
15.
go back to reference Nakamura K, Sekijima Y, Nakamura K, Hattori K, Nagamatsu K, Shimizu Y, Yasude T, Ushiyama M, Endo F, Fukushima Y, Ikeda S: Cerebral hemorrhage in Fabry's disease. J Hum Genet. 2010, 55: 259-261. 10.1038/jhg.2010.18.CrossRefPubMed Nakamura K, Sekijima Y, Nakamura K, Hattori K, Nagamatsu K, Shimizu Y, Yasude T, Ushiyama M, Endo F, Fukushima Y, Ikeda S: Cerebral hemorrhage in Fabry's disease. J Hum Genet. 2010, 55: 259-261. 10.1038/jhg.2010.18.CrossRefPubMed
16.
go back to reference Sims K, Politei J, Banikazemi M, Lee P: Stroke in Fabry disease frequently occurs before diagnosis and in the absence of other clinical events: natural history data from the Fabry Registry. Stroke. 2009, 40: 788-794. 10.1161/STROKEAHA.108.526293.CrossRefPubMed Sims K, Politei J, Banikazemi M, Lee P: Stroke in Fabry disease frequently occurs before diagnosis and in the absence of other clinical events: natural history data from the Fabry Registry. Stroke. 2009, 40: 788-794. 10.1161/STROKEAHA.108.526293.CrossRefPubMed
17.
go back to reference Spengos K, Vemmos K: Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 - the Athens young stroke registry. Eur J Neurol. 2010, 17: 1358-1364.CrossRefPubMed Spengos K, Vemmos K: Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 - the Athens young stroke registry. Eur J Neurol. 2010, 17: 1358-1364.CrossRefPubMed
Metadata
Title
Lessons from everyday stroke care for clinical research and vice versa: comparison of a comprehensive and a research population of young stroke patients
Authors
Christian Tanislav
Ulrike Grittner
Bjoern Misselwitz
Gerhard Jan Jungehuelsing
Christian Enzinger
Bettina von Sarnowski
Jukka Putaala
Manfred Kaps
Peter Kropp
Arndt Rolfs
Turgut Tatlisumak
Franz Fazekas
Edwin Kolodny
Bo Norrving
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2014
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-14-45

Other articles of this Issue 1/2014

BMC Neurology 1/2014 Go to the issue