Mortality prediction in critical care for acute stroke: Severity of illness–score or coma–scale?

Handschu, René; Haslbeck, Mathias; A, Hartmann; Fellgiebel, Andreas; Kolominsky-Rabas, Peter; Schneider, Dietmar; Berrouschot, Jörg; Erbguth, Frank; Reulbach, Udo

doi:10.1007/s00415-005-0853-5

Cited by 37 publications

(25 citation statements)

References 27 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most previous studies have focused on ICU or in-hospital mortality. However, short-term (≤ 3 months) mortality has been reported to be in the range 46 – 90% (7, 10, 11, 15, 16, 20, 34–37); this compares to a 30-day mortality in our sample of 65%. Older and smaller studies have generally reported higher mortality rates.…”

Section: Discussioncontrasting

confidence: 69%

“…Firstly, studies have been conducted in a number of countries, likely with differing practices in the intensive care unit management of stroke. Secondly, very small numbers of patients have been included, ranging from 58 to 138, mostly in single centers (3–5, 7, 8). Finally, there has been no uniformity in the type of stroke patient studied, with reports including either hemorrhagic stroke, ischemic stroke or both.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term survival in older critically ill patients with acute ischemic stroke*

Golestanian

Liou

Smith

2009

Critical Care Medicine

View full text Add to dashboard Cite

Objective-To compare survival in older patients with acute ischemic stroke admitted to intensive care units (ICU) with those not requiring ICU care and to assess the impact of mechanical ventilation (MV) and percutaneous gastrostomy tubes (PEG) on long-term mortality.Design-Multi-center retrospective cohort study.Setting-Administrative data from the Centers for Medicare and Medicaid Services covering 93 metropolitan counties primarily in the Eastern half of the United States.Patients-31,301 patients discharged with acute ischemic stroke in 2000. Interventions-NoneMeasurements-Mortality from the time of index hospitalization up to the end of the follow-up period of 12 months. Information was also gathered on use of mechanical ventilation, percutaneous gastrostomy, sociodemographic variables and a host of comorbid conditions.Main Results-26% of all patients with acute ischemic stroke required ICU admission. The crude death rate for ICU stroke patients was 21% at 30 days and 40% at 1-year follow-up. At 30 days, after adjustment of sociodemographic variables and comorbidities, ICU patients had a 29% higher mortality hazard compared to non-ICU patients. Mechanical ventilation was associated with a fivefold higher mortality hazard (hazard ratio 5.59, confidence interval 4.93-6.34). The use of PEG was not associated with mortality at 30 days. By contrast, at 1-year follow up in 30-day survivors, ICU admission was not associated with mortality hazard (hazard ratio 1.01; 95% confidence interval 0.93-1.09). Mechanical ventilation still had a higher risk of death (hazard ratio 1.88, 95% confidence interval 1.57-2.25), and PEG patients had a 2.59 fold greater mortality hazard (95% confidence interval 2.38-2.82).Correspondence to: Ellie Golestanian. All work was performed at the University of Wisconsin School of Medicine and Public Health.No reprints will be ordered.The authors have no potential conflicts of interest to disclose. NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2010 December 1. Conclusions-Both short-term and long-term mortality in older patients with acute ischemic stroke admitted to ICUs is lower than previously reported. The need for MV and PEG are markers for poor long-term outcome. Future research should focus on the identification of clinical factors that lead to increased mortality in long-term survivors and efforts to reduce those risks.

show abstract

Section: Discussioncontrasting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Long-term survival in older critically ill patients with acute ischemic stroke*

Golestanian

Liou

Smith

2009

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…In our study, coma at admission was a strong predictor of in-hospital mortality. In line with this finding, several studies demonstrated a correlation of initial GCS and short-term mortality [21,25,26] . However, only two studies including >100 patients -both originating from Asian countries -evaluated the NIHSS score in their patient collectives as a stroke-specific severity marker [16,25] .…”

Section: Discussion and Review Of The Literaturesupporting

confidence: 52%

Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Alonso¹,

Ebert²,

Kern³

et al. 2015

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: The prognosis of stroke patients admitted to intensive care units (ICU) is commonly regarded to be poor. However, only limited data regarding outcome predictors are available. Patients and Methods: Out of 4,958 consecutive patients admitted to our stroke unit with the diagnosis of acute stroke, after analysis we identified 347 patients (164 male) in need of ICU management. In-hospital and post-rehabilitation mortality as well as functional outcome at discharge and after rehabilitation were analyzed. Results: Ischemic stroke was diagnosed in 252 patients (72.6%) and intracerebral hemorrhage occurred in 95 patients (27.4%). The mean age in our cohort was considerably high (70.8 years). One hundred patients were comatose at admission. The median NIHSS score at admission in the remaining patients was 12. Apart from stroke-related disturbances of consciousness (47.1%), the most common reasons for ICU treatment were cardiac (23.4%) and respiratory (12.1%) complications or interventional procedures requiring mechanical ventilation (11%). In all, 231/347 patients (66.6%) were mechanically ventilated (mean 84 h). In-hospital mortality (143/347; 41.2%) was associated with old age, poor NIHSS score at admission, intracerebral hemorrhage and mechanical ventilation (p < 0.001 in all). Further, admission to ICU because of stroke-related impairment of consciousness increased in-hospital mortality (p < 0.001). Similarly, poor outcome after rehabilitation was associated with old age (p = 0.029) and mechanical ventilation (p < 0.001). In patients ≥80 years with either intracerebral hemorrhage or need of mechanical ventilation, outcome was unfavorable in nearly any case. However, the overall post-rehabilitation outcome did not differ between patients with intracerebral hemorrhage and ischemic stroke (p = 0.275). Conclusion: The stroke population in our study was associated with an increased early mortality; however, given the same conditions, it was old with a high percentage of patients requiring mechanical ventilation. This did not result in increased in-hospital mortality rates compared to younger and less severely affected cohorts. Thus, ICU management is a life-saving initiative even among the elderly. However, the functional outcome was poor in older patients, thus limiting the benefits of ICU care in these patients.

show abstract

“…Therefore the higher percentage of infratentorial lesions in the AS group should have resulted in a higher rather than a lower case fatality. However, populations have not been analyzed for the occurrence of the prognostic factors of morbidity of patient with stroke, such as Glasgow Coma Scale (Handschu et al, 2005) or cardiovascular risk factors.…”

Section: The Influence Of Differences Between Patient Groupsmentioning

confidence: 99%

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Knake¹,

Rochon

Fleischer³

et al. 2006

Epilepsia

View full text Add to dashboard Cite

Summary:Purpose: The aim of this study was to determine the long-term case fatality of patients with a first episode of status epilepticus (SE group) of cerebrovascular etiology, as compared with that in acute stroke patients without SE (AS group).Methods: Patients with SE who had been prospectively admitted to an epidemiologic study were retrospectively compared with a cohort of patients from the local stroke registry. The main outcome end point was overall survival. Survival curves were generated according to the Kaplan-Meier method and compared by using the log-rank test. An extended Cox model was used to examine the impact of patient group on the risk of death. Covariates considered potential confounders included age at diagnosis, sex, type of stroke, affected hemisphere, and localization of lesions.Results: Of 166 patients who entered the study, 93 patients were in the SE group, and 73 patients were in the AS group; 53 SE patients and 35 AS patients died during the study. Patient group (SE vs. AS) showed no significant impact on survival (p = 0.0832) in univariate analysis. In contrast, the results from a multivariable analysis suggest that after 6 months, patients with SE were at about twice the risk of death as were patients with AS [hazard ratio of 2.12 with 95% confidence interval, 1.04-4.32, p = 0.0392].Conclusions: The occurrence of SE in patients with cerebrovascular disease indicates a high risk of death within 3 years. In contrast, the case fatality risk attributable to recurrent status or seizures is lower. Key Words: Long-term mortality-Case fatality-Risk factors-Causes of death-Status epilepticus.Status epilepticus (SE) is a major neurologic emergency with an incidence of ∼20/100,000 for the white population in industrialized countries. Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al., 1994;Towne et al., 1994;Logroscino et al., 1997).SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al., 1995;Logroscino et al., 1997;Lowenstein and Alldredge, 1998;Knake et al., 2001;Rosenow et al., 2002;Wu et al., 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease. and duration of SE were main predictors of increased short-term mortality (Hauser, 1990;Lowenstein and Alldredge, 1998;Wu et al., 2002 In contrast, available reports examining long-term mortality after SE are sparse. Only one recent study systematically analyzed mortality at more than 10 years after the first episode of SE and found an increased long-term mortality of 43%, significantly associated with older age, status duration >24 h, acute symptomatic etiology including stroke, and myoclonic SE caused by hypoxic brain injury (Logroscino et al., 2002).The authors concluded that SE alone...

show abstract

Mortality prediction in critical care for acute stroke: Severity of illness–score or coma–scale?

Abstract: SAPS II and SAPS (I) but also the GCS are valuable tools for prediction of short and long-term mortality in acute stroke patients treated in NCCU. The GCS as a predictor for mortality in stroke patients could be further simplified by using its subscore "best motor response" alone.

Cited by 37 publications

References 27 publications

Long-term survival in older critically ill patients with acute ischemic stroke*

Long-term survival in older critically ill patients with acute ischemic stroke*

Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Contact Info

Product

Resources

About