Predictors of Discharge to Home after Thrombolytic Treatment in Right Hemisphere Infarct Patients

Abstract

BackgroundThe aim of the study was to assess the association between thrombolysis and length of hospital stay after right hemisphere (RH) infarct, and to identify which cognitive functions were predictive of discharge.MethodsThe study group consisted of 75 acute RH patients. Thirty-three patients had thrombolysis. Neuropsychological examinations were performed within 11 days of stroke onset. The cognitive predictors were visual neglect, visual memory, visual search and reasoning and visuoconstructive abilities. The outcome variable was time from stroke to discharge to home.ResultsThrombolysis emerged as a statistically significant predictor of discharge time in patients with moderate/severe stroke (NIHSS ≥5). In the total series of patients and in patients with mild stroke (NIHSS <5), thrombolysis was not significantly associated with discharge time. Milder visuoconstructive defects shortened the hospital stay of the whole patient group and of patients with moderate/severe stroke. In all patient groups, independence in activities of daily living (ADL) was a significant single predictor of a shorter hospital stay. The best combination of predictors for discharge was independence in ADL in the total series of patients and in patients with mild stroke, and thrombolysis and independence in ADL in patients with moderate/severe stroke.ConclusionsThrombolytic treatment was a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct, while cognitive functions had less predictive power.

Blood pressure variability at different time periods within first 24 hours after admission and outcomes of acute ischemic stroke

“…Poor outcome at day 7 (short term) was defined by NIHSS score ≥5 in hospital . We estimated the functional outcome after discharge using the ordinal score on the modified Rankin scale (mRS; range, 0‐6, with higher scores indicating greater disability) at 3, 6, and 12 months (long term) visit.…”

“…in hospital. 21 We estimated the functional outcome after discharge using the ordinal score on the modified Rankin scale (mRS; range, 0-6, with higher scores indicating greater disability) at 3, 6, and 12 months (long term) visit. The mRS score was used as a clinician-reported measure of global disability and assessed by professional neurologists, and functional independence (defined as a score on the mRS of 0-2) represented a good outcome, whereas functional dependence (defined as a score on the mRS of ≥3) represented a poor one.…”

Predictors of functional outcome after right hemisphere stroke in patients with or without thrombolytic treatment

“…Our finding about thrombolysis not being a statistically significant predictor of instrumental functional outcome (IADL), although it has been shown to be a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct (Ruuskanen et al, 2010), suggests that also in future studies functional outcome should be evaluated taking into account both ADL and IADL outcome. Since our findings differ from those of Nys et al (2006), further research is needed with larger RH and LH stroke patient groups.…”

“…However, in a recent study by our study group (Ruuskanen et al, 2010) it was found that thrombolysis was a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct. Considering those results, it can be hypothesized that our IADL functional outcome measure (FAI) was not sensitive enough to separate the functional outcome of this patient group although in basic ADL functions measured by hospitalization time significant connection to thrombolysis was found.…”

“…In thrombolytic treatment it is possible to decrease the brain damage caused by stroke by restoring the flow of blood to the area with the help of medication (Wardlaw, del Zoppo, Yamaguchi, & Berge, 2007). A recent study by our study group (Ruuskanen et al, 2010) found that thrombolysis was a significant predictor of earlier discharge to home…”