No benefit of flat head positioning in early moderate-severe acute ischaemic stroke: a HeadPoST study subgroup analysis

Abstract

Background: Although the Head Positioning in acute Stroke Trial (HeadPoST) showed no effect of the flat head position (FP; vs sitting up head position (SUP)) on functional outcome, we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke (AIS) of at least moderate severity.

Methods: Subgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale (NIHSS) scores ≥7, ≥10 and ≥14, randomised to FP or SUP <4.5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale (mRS) and death/disability (mRS scores 3-6), and any cardiovascular serious adverse event. Logistic regression analyses were undertaken adjusted for study design and baseline risk factors.

Results: There was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores: adjusted OR and 95% CI for ordinal shift and binary (3-6) mRS scores: for NIHSS ≥7 (n=867) 0.92 (0.67 to 1.25) and 0.74 (0.52 to 1.04); NIHSS ≥ 10 (n=606) 0.80 (0.58 to 1.10) and 0.77 (0.49 to 1.19); NIHSS ≥14 (n=378) 0.82 (0.54 to 1.24) and 1.22 (0.69 to 2.14).

Conclusions: Early FP had no significant effect in patients with moderate-severe AIS.

Trial registration number: NCT02162017.

Keywords: stroke.

Conflict of interest statement

Competing interests: AB reports research grants from Clínica Alemana de Santiago. PML reports research grants from The George Institute, Clínica Alemana de Santiago, and the Chilean Government, personal fees from Bristol Meyer Squibb, AstraZeneca and Bayer, and an unrestricted research grant from Lundbeck. TR is a National Institutes for Health Research Senior Investigator. VVO reports research grants from Clínica Alemana de Santiago, Boehringer-Ingelheim and Conicyt. PM-V reports research grants from Clínica Alemana de Santiago. MLH holds a National Health and Medical Research Council (NHMRC) of Australia Career Development Fellowship. SM is a member of the NHMRC Research Committee in 2015–2018. OP-N reports research grants for the Brazilian Stroke Research Network from the Brazilian government. CSA holds an NHMRC Senior Principal Research Fellowship, and reports honoraria and travel reimbursement from Takeda, Boehringer Ingelheim and Amgen.

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