Philip Chang, MD

Anderson CS, Arima H, Lavados P, Billot L, Hackett ML, Olavarría VV, et al. Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke. N Engl J Med. 2017

This article by Anderson et al investigates the role of supine bedrest positioning after acute stroke and weighed it against the risk of aspiration pneumonia. In this trial, 11,093 patients were randomized to supine or head-up (defined as at least 30 degrees head of bed elevation) initiated after hospital admission and maintained for 24 hours. The primary outcome was mRS scores at 90 days. The results of the article showed that people who were supine were less likely to maintain a supine position for 24 hours (87% vs. 95%, p<0.001), and there was no difference in mRS scores at 90 days. In addition, there were no significant differences in serious adverse events between the two groups, including the rates of aspiration pneumonia. The authors of the trial suggest that any modification of cerebral blood flow that may have occurred as a result of head positioning initiated within 24 hours was insufficient to reduce neurologic deficit associated with acute stroke.