The frequency and outcomes of neurologic deterioration early after stroke have not been well characterized. This study was designed to better understand the predictors and outcomes of neurological deterioration among patients in the first hours after the identification of stroke symptoms.

Data were analyzed from the Field Administration of Stroke Therapy-Magnesium (FAST MAG) trial. The Glasgow Coma Scale (GCS) was administered before hospital arrival by paramedics, at the time of arrival by emergency department (ED) personnel and later during the emergency department course of care. Ultra-Early Neurologic Deterioration (U-END) was defined as worsening by two or more points on the GCS between ambulance arrival and ED arrival.

Data were completed for 1，690 patients with a mean age of 69.4 years. Of these, U-END occurred in 11.8%. Among those who were assigned a final diagnosis of ICH, early deterioration occurred in 30.8% at three months. A good functional outcome, defined as a Barthel index score of zero to two occurred in 16% among those with U-END and in 56.6% among those without U-END (P＝ 0.001)．

This study of patients with acute stroke found that deterioration in clinical status between ambulance arrival and emergency department evaluation occurs more frequently in those with intracranial hemorrhage, and is associated with significantly reduced functional independence at three months.