{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T10:31:59Z","timestamp":1769077919050,"version":"3.49.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":287,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patients with acute stroke are at risk of respiratory or circulatory compromise resulting in vital instability, which can be captured through the widely used aggregated National Early Warning Score (NEWS). We aimed to assess the relation between vital instability (defined as NEWS of five or higher) and death or dependency at 90\u2009days after stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this observational cohort study we studied 763 patients with ischaemic stroke (n\u2009=\u2009400), intracerebral haemorrhage (ICH) (n\u2009=\u2009146) or subarachnoid haemorrhage (SAH) (n\u2009=\u2009217), hospitalized to a Dutch tertiary referral hospital from 1 January 2017 to 31 December 2018. We calculated NEWS for each 8\u2009h time span during the first 72\u2009h after hospitalization. We also decomposed NEWS into its three components respiration, circulation and consciousness. The primary outcome was death or dependency (modified Rankin Scale score \u2a7e3) at 90\u2009days after stroke. The association of vital instability with functional dependency was examined using Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Two hundred and twenty-seven (58%) patients with ischaemic stroke, 101 (69%) with ICH and 142 (65%) with SAH had at least one episode of vital instability. In patients with ischaemic stroke or SAH, vital instability was associated after adjustment for confounders with death or dependency (adjusted relative risk 1.55 ((95% CI) 1.25\u20131.93 and 2.13 (1.35\u20133.36), respectively)). This was mainly driven by impaired consciousness, which was associated with death or dependency in all types of stroke. Respiratory insufficiency and circulatory instability were associated with death or dependency only in SAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Vital instability in the first 72\u2009h of hospitalization for ischaemic stroke or SAH is associated with death or dependency at 90\u2009days. Impaired consciousness was the main driver of this relationship. NEWS may not be appropriate for patients with acute stroke, mainly due to the dichotomous manner in which the level of consciousness is classified, and modification of NEWS should be considered for these patients<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873241263195","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T01:27:12Z","timestamp":1722389232000},"page":"248-257","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Is NEWS of value for patients with acute stroke?"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1242-994X","authenticated-orcid":false,"given":"Mari\u00eblle K","family":"van Valburg","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands"},{"name":"Department of Anesthesiology and Intensive Care, Amphia Hospital, Breda, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisette M","family":"Vernooij","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands"},{"name":"Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands"},{"name":"Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelis J","family":"Kalkman","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9891-2136","authenticated-orcid":false,"given":"H Bart","family":"van der Worp","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,3,1]]},"reference":[{"key":"2026012113070262100_bibr1-23969873241263195","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S1474-4422(09)70266-2","article-title":"Medical complications after stroke","volume":"9","author":"Kumar","year":"2010","journal-title":"Lancet Neurol"},{"key":"2026012113070262100_bibr2-23969873241263195","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1161\/STROKEAHA.114.005845","article-title":"Characteristic adverse events and their incidence among patients participating in acute ischemic stroke trials","volume":"45","author":"Hesse","year":"2014","journal-title":"Stroke"},{"key":"2026012113070262100_bibr3-23969873241263195","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0144626","article-title":"Non-invasive continuous 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