RT Journal Article SR Electronic T1 No benefit of flat head positioning in early moderate–severe acute ischaemic stroke: a HeadPoST study subgroup analysis JF Stroke and Vascular Neurology JO Stroke Vasc Neurol FD BMJ Publishing Group Ltd SP 406 OP 409 DO 10.1136/svn-2020-000387 VO 5 IS 4 A1 Alejandro M Brunser A1 Menglu Ouyang A1 Hisatomi Arima A1 Pablo M Lavados A1 Thompson Robinson A1 Paula Muñoz-Venturelli A1 Verónica V Olavarría A1 Laurent Billot A1 Marre L Hackett A1 Lili Song A1 Sandy Middleton A1 Octavio Pontes-Neto A1 Tsong-Hai Lee A1 Caroline Watkins A1 Craig S Anderson YR 2020 UL http://svn.bmj.com/content/5/4/406.abstract AB Background Although the Head Positioning in acute Stroke Trial (HeadPoST) showed no effect of the flat head position (FP; vs sitting up head position (SUP)) on functional outcome, we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke (AIS) of at least moderate severity.Methods Subgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale (NIHSS) scores ≥7, ≥10 and ≥14, randomised to FP or SUP <4.5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale (mRS) and death/disability (mRS scores 3–6), and any cardiovascular serious adverse event. Logistic regression analyses were undertaken adjusted for study design and baseline risk factors.Results There was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores: adjusted OR and 95% CI for ordinal shift and binary (3–6) mRS scores: for NIHSS ≥7 (n=867) 0.92 (0.67 to 1.25) and 0.74 (0.52 to 1.04); NIHSS ≥ 10 (n=606) 0.80 (0.58 to 1.10) and 0.77 (0.49 to 1.19); NIHSS ≥14 (n=378) 0.82 (0.54 to 1.24) and 1.22 (0.69 to 2.14).Conclusions Early FP had no significant effect in patients with moderate–severe AIS.Trial registration number NCT02162017.