Document resource
Background/Objectives Previous studies have demonstrated that performing computed tomography (CT) alone for acute ischaemic stroke is non-inferior to CT and magnetic resonance imaging (MRI) for selected patients. However, aspects of local practices may influence such outcomes. This study sought to reproduce these study findings in a different, Australian, population.Methods This study involved a statewide 12-month retrospective cohort. This cohort included all ischaemic stroke admissions to stroke/neurology departments during the study period who survived to discharge. Propensity score matching was employed, and 1-year mortality was compared between patients who had an inpatient MRI and those who did not.Results There were 1,249 patients included in the study. The majority of patients, 896/1,249 (71.7%), had an MRI as an inpatient. The relative risk for 1-year mortality associated with having an inpatient MRI was 0.66 (95% confidence interval 0.39 to 1.11), demonstrating a non-significant trend toward lower mortality in those who had inpatient MRI. Therefore, non-inferiority was not demonstrated. When 1-year mortality was evaluated following propensity score matching, there was no significant difference between those who had inpatient MRI and those who did not (8.4% vs 12.8%, P = 0.15).Conclusion This study has not reproduced the previous results that demonstrated non-inferiority of a CT-only approach. There are multiple possible reasons for these differing results. Particularly in the setting of uncertainty, clinician discretion and shared decision-making processes remain vital, as always.