Methodology: 3.5/5
Usefulness: 3.5/5
Alexandrov AW, et al. JAMA Neurol. 2025 Sep 1;82(9):905-914. doi: 10.1001/jamaneurol.2025.2253.
Question and Methods: Authors aimed to determine if 0° head positioning reduces neurological deterioration and mortality in stroke patients awaiting thrombectomy, using a randomized, outcome-blinded trial.
Findings: Neurological deterioration occurred in 2.2% (0°) vs. 55.3% (30°) (ARR 53.1%, RRR 96%, HR 34.40, 95% CI, NNT 2, p < 0.001); 90-day mortality was 4.4% (0°) vs. 21.3% (30°) (ARR 16.9%, RRR 79%, NNT 6, p = 0.03).
Limitations: Small sample size, and lack of long-term functional outcomes may limit generalizability although the results are quite significant.
Interpretation: Flat head positioning may improve early outcomes in stroke patients awaiting thrombectomy and could be safely adopted in emergency stroke protocols.
JC Supervisor: Dr. Ian Stiell
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