HeadPoST

Rightly positioned, or flat out wrong?

Anne Alexandrov, Georgios Tsivgoulis, Michael D. Hill, David S. Liebeskind, Peter Schellinger, Bruce Ovbiagele, Adam Arthur, Valeria Caso, Raul G. Nogueira, J. Claude Hemphill, James C. Grotta, Werner Hacke, Andrei V. Alexandrov

Research output: Contribution to journalArticle

Abstract

ObjectiveTo critique the Head Positioning in Stroke Trial (HeadPoST) study methods in relation to preceding research findings in an aim to clarify the potential efficacy of positioning interventions and direction for future research.MethodsHead positioning research prior to the conduct of HeadPoST was reviewed by a team of international stroke experts, and methods and findings were compared to HeadPoST.ResultsMethods used to select HeadPoST patients differ substantially from those used in original head positioning studies, in particular enrollment of all types of stroke. HeadPoST enrolled primarily minor strokes (median NIH Stroke Scale 4, interquartile range [IQR] 2-8) without vascular imaging confirmation of subtype; elapsed time from stroke symptom onset to the initiation of intervention was late (median 14 hours, IQR 5-35), and time from hospital admission to enrollment was delayed (median 7 hours, IQR 2-26). Intervention integrity was not reported, including ability to achieve/maintain 30° head elevation in beds lacking head elevation capabilities. Deterioration or improvement associated with the intervention is unknown as serial assessments were not completed, and the trial's 3-month outcome was powered using unrelated study data.ConclusionsThe design of HeadPoST was suboptimal to measure differences produced by the intervention. Future head positioning trials in discrete patient cohorts (in particular, large vessel occlusion) with endpoints supported by pilot work are required to understand the efficacy of this simple yet potentially important intervention.

Original languageEnglish (US)
Pages (from-to)885-889
Number of pages5
JournalNeurology
Volume90
Issue number19
DOIs
StatePublished - Jan 1 2018

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Stroke
Head
Research
Blood Vessels

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Alexandrov, A., Tsivgoulis, G., Hill, M. D., Liebeskind, D. S., Schellinger, P., Ovbiagele, B., ... Alexandrov, A. V. (2018). HeadPoST: Rightly positioned, or flat out wrong? Neurology, 90(19), 885-889. https://doi.org/10.1212/WNL.0000000000005481

HeadPoST : Rightly positioned, or flat out wrong? / Alexandrov, Anne; Tsivgoulis, Georgios; Hill, Michael D.; Liebeskind, David S.; Schellinger, Peter; Ovbiagele, Bruce; Arthur, Adam; Caso, Valeria; Nogueira, Raul G.; Hemphill, J. Claude; Grotta, James C.; Hacke, Werner; Alexandrov, Andrei V.

In: Neurology, Vol. 90, No. 19, 01.01.2018, p. 885-889.

Research output: Contribution to journalArticle

Alexandrov, A, Tsivgoulis, G, Hill, MD, Liebeskind, DS, Schellinger, P, Ovbiagele, B, Arthur, A, Caso, V, Nogueira, RG, Hemphill, JC, Grotta, JC, Hacke, W & Alexandrov, AV 2018, 'HeadPoST: Rightly positioned, or flat out wrong?', Neurology, vol. 90, no. 19, pp. 885-889. https://doi.org/10.1212/WNL.0000000000005481
Alexandrov A, Tsivgoulis G, Hill MD, Liebeskind DS, Schellinger P, Ovbiagele B et al. HeadPoST: Rightly positioned, or flat out wrong? Neurology. 2018 Jan 1;90(19):885-889. https://doi.org/10.1212/WNL.0000000000005481
Alexandrov, Anne ; Tsivgoulis, Georgios ; Hill, Michael D. ; Liebeskind, David S. ; Schellinger, Peter ; Ovbiagele, Bruce ; Arthur, Adam ; Caso, Valeria ; Nogueira, Raul G. ; Hemphill, J. Claude ; Grotta, James C. ; Hacke, Werner ; Alexandrov, Andrei V. / HeadPoST : Rightly positioned, or flat out wrong?. In: Neurology. 2018 ; Vol. 90, No. 19. pp. 885-889.
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