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Severe disability at hospital discharge in ischemic stroke survivors
M Paciaroni1, P Arnold, G Van Melle
1Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Insights
Predicting stroke recovery is possible within hours of onset. Key indicators like impaired consciousness and limb weakness predict severe disability, while age is not a factor. Early insights aid rehabilitation planning.
Area of Science:
- Neurology
- Clinical Neuroscience
- Rehabilitation Medicine
Background:
- Predicting functional prognosis after stroke remains challenging due to conflicting study results.
- This study aimed to identify predictors of functional outcome in first-time stroke patients.
Purpose of the Study:
- To predict the functional outcome at discharge for first-time stroke patients.
- To identify key variables influencing functional status post-stroke.
Main Methods:
- Analysis of 3,628 first-ever stroke patients from the Lausanne Stroke Registry.
- Functional status assessed using the modified Rankin scale at discharge.
- Multivariate logistic regression applied to identify independent predictors of outcome.
Main Results:
- Impaired consciousness, limb weakness, progressive worsening, middle cerebral artery infarcts, ischemic heart disease, and cardiac arrhythmia predicted severe disability.
- Age was not an independent predictor of poor outcome.
- Hypercholesterolemia was associated with a better functional outcome.
Conclusions:
- Prognostic indicators for functional outcome are identifiable within hours of stroke onset.
- Early identification of predictors is crucial for patient management and rehabilitation planning.
Background:
Several studies have attempted to identify criteria for predicting functional prognosis after stroke, but often with contradictory results. The purpose of this study was to predict the functional outcome at discharge of first-time stroke patients included consecutively in the Lausanne Stroke Registry.
Methods:
We studied 3,628 sequential patients with first-ever stroke who were admitted consecutively to the Centre Hospitalier Universitaire Vaudois. Functional status was evaluated using the Rankin disability scale at discharge. We studied the prognostic value of historical, clinical and instrumental variables related to functional outcome at discharge. The factors studied were age, sex, risk factors, ECG results, occurrence of transient ischemic attacks (TIAs), extension of cerebral infarction, presumed cause of stroke, clinical findings and demographic characteristics. Univariate analysis was performed on each variable by comparing the number of functionally independent with that of dependent patients at the moment of discharge. The significant variables of the univariate analysis were subjected to multivariate analysis with a backward logistic regression procedure to find those with an independent effect on the outcome.
Results:
A total of 3,156 patients, excluding 117 patients with ischemic stroke who died during hospitalization and 355 with brain hemorrhage, were included; 2,867 patients belonged to the nil, mild or moderate disability groups (modified Rankin score 1-4; functionally at least partially independent patients), while 291 patients belonged to the severe disability group (modified Rankin score 5; functionally dependent patients). The mean duration of stay in hospital of the severe disability group was 31.2 days (SD = 16.2). Multivariate analysis showed that impaired consciousness on admission, limb weakness, progressive worsening, infarct in the superficial and deep territory of the middle cerebral artery, ischemic heart disease and cardiac arrhythmia were predictors of severe disability at discharge. Age was not an independent predictor of poor outcome. Hypercholesterolemia was significantly related to a better outcome.
Conclusions:
Some prognostic indicators associated with functional outcome at discharge are available during the first few hours after onset of stroke. This is important for the management of the individual stroke patient and for organizing suitable rehabilitation planning.