Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation

Abstract

Background Despite improvements in the critical care management of subarachnoid hemorrhage (SAH), a substantial number of patients still suffer from disabilities. In most areas of the world, longitudinal follow-up is not routinely performed, and the patient’s trajectory remains unknown. Methods We prospectively collected data of 298 consecutive patients with spontaneous SAH and evaluated clinical trajectories at discharge, 3 months, and 1 year after SAH. In a subgroup of patients transferred to a local neurorehabilitation center (Rehab-Hochzirl), we studied the effects of rehabilitation intensity on clinical trajectories. Any decrease in the modified Rankin Scale (mRS) was defined as an improvement, with mRS ≤ 2 indicating good outcome. We used multivariate generalized linear models to investigate associations with clinical trajectories. Results Out of the 250 surviving patients, 35% were transferred directly to Rehab-Hochzirl (n = 87 of 250; mRS at discharge = 4), 11% were transferred to another rehabilitation center (n = 27 of 250; mRS = 1), 1% were transferred to a nursing home (n = 3 of 250; mRS = 5), 21% were transferred to their country of origin (n = 52 of 250; mRS = 4), and 32% (n = 79 of 250; mRS = 1) were discharged home. Functional outcome improved in 57% (n = 122 of 215) of patients during the first 3 months, with an additional 16% (35 of 215) improving between 3 and 12 months, resulting in an overall improvement in 73% (n = 157 of 215) of survivors. After 1 year, 60% (n = 179 of 250) of patients were functionally independent. A lower Hunt and Hess scale score at intensive care unit admission, younger age, a lower mRS at intensive care unit discharge, fewer days on mechanical ventilation, and male sex were independently associated with better functional recovery. Although the subgroup of patients transferred to Rehab-Hochzirl were more severely affected, 60% (52 of 87) improved during inpatient neurorehabilitation. Conclusions Our results indicate ongoing functional improvement in a substantial number of patients with SAH throughout a follow-up period of 12 months. This effect was also observed in patients with severe disability receiving inpatient neurorehabilitation.

Lumbar puncture-verified subarachnoid hemorrhage: bleeding sources, need of radiological examination, and functional recovery

“…Although information on the symptoms exhibited by the patient post SAH was not gathered in this study, it is known that, e.g., attention and memory deficits, chronic fatigue, and behavioral changes are common sequelae following aSAH [ 28 ]. It is likely that neurorehabilitation based on identifying the patient’s problems may be beneficial [ 21 ]. There are also some emerging adjunct therapies, such as repetitive transcranial magnetic stimulation, which may enhance neurological recovery after acute brain injuries [ 12 ].…”

Neurocranial Pharmacodialysis Device for subarachnoid hemorrhage treatment—a perspective

“…Importantly, severe cases of SAH with IV and V grades on the World Federation of Neurosurgical Societies (WFNS) scale, corresponding with 3-12 grades of the Glasgow Coma Scale (GCS), still have a high, more than 50%, mortality rate even in hospital environments: an outcome virtually unchanged since the 1960s [3,4]. Among the survivors of SAH, the morbidity rate is substantial with at least 40% of these patients remaining disabled and dependent for more than a year whether in rehabilitation centers or at home [5].…”