What Determines Good Recovery in Patients With the Most Severe Strokes?

Abstract

Background and Purpose-Even patients with the most severe strokes sometimes experience a remarkably good recovery.We evaluated possible predictors of a good outcome to search for new therapeutic strategies. Methods-We included the 223 patients (19%) with the most severe strokes (Scandinavian Stroke Scale score Ͻ15 points) from the 1197 unselected patients in the Copenhagen Stroke Study. Of these, 139 (62%) died in the hospital and were excluded. The 26 survivors (31%) with a good functional outcome (Barthel Index Ն50 points) were compared with the 58 survivors (69%) with a poor functional outcome (Barthel Index Ͻ50 points). The predictive value of the following factors was examined in a multivariate logistic regression model: age; sex; a spouse; work; home care before stroke; initial stroke severity; blood pressure, blood glucose, and body temperature on admission; stroke subtype; neurological impairment 1 week after onset; diabetes; hypertension; atrial fibrillation; ischemic heart disease; previous stroke; and other disabling disease. Results-Decreasing age (odds ratio [OR], 0.50 per 10-year decrease; 95% CI, 0.25 to 0.99; Pϭ0.04), a spouse (OR, 3.1; 95% CI, 1.1 to 8.8; Pϭ0.03), decreasing body temperature on admission (OR, 1.8 per 1°C decrease; 95% CI, 1.1 to 3.1; Pϭ0.01), and neurological recovery after 1 week (OR, 3.2 per 10-point increase in Scandinavian Stroke Scale score; 95% CI, 1.1 to 7.8; Pϭ0.01) were all independent predictors of good functional outcome. Conclusions-Patients with the most severe strokes who achieve a good functional outcome are generally characterized by younger age, the presence of a spouse at home, and early neurological recovery. Body temperature was a strong predictor of good functional outcome and the only potentially modifiable factor. We suggest that a randomized controlled trial be undertaken to evaluate whether active reduction of body temperature can improve the generally poor prognosis of patients with the most severe strokes.

Prognosis of non traumatic coma: The role of some socio-economic factors on its outcome in Ibadan, Nigeria

“…This report is in consonance with those of Cullen et al [9] and Jorgensen et al [25] These studies suggested that less aggressive care for the elderly by family members and health care providers was responsible for poor functional outcome, while the presence of a spouse was a strong predictor of a good functional outcome in young patients with the most severe strokes. [25] High-risk lifestyle behaviors [2] such as cigarette smoking, alcohol and/or substance abuse, and physical inactivity when associated with diabetes mellitus, hyperlipidemia, homocysteinemia, hypertension, atherogenic dyslipidemia, visceral obesity, impaired fibrinolysis, and left ventricular dysfunction, individually and collectively, contribute to poor outcome in renal, metabolic, cerebrovascular, and/or cardiovascular events. It is, therefore, hoped that with the identification of many prognostic factors by this study supported by those of earlier studies, health care providers would be able to improve the outcome of coma.…”

“…32.5% (65) of the patients who presented after 6 h were referred from primary and secondary health facilities with a mortality rate of 89.6%, while the other 12.5% (25) brought in directly from their homes had a mortality rate of 68.7% (χ 2 =1.00, P=0.00).…”

The influence of demographic, environmental and physical factors on functional independence post stroke

“…(See Table 3) However this influence was only at discharge from hospital. This finding is similar to that of Jorgensen et al (1999) and Pohjahsvaara et al (1997) who established that younger patients have better functional outcomes at discharge from hospital and that older patients deteriorate significantly more in activities of daily living. Functional independence more than six weeks post discharge was not dependent on the patient's age (p = 0.37).…”

Stroke severity, early recovery and outcome are each related with clinical classification of stroke: Data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST)

“…Furthermore, early improvement was significantly associated with a good outcome. Spontaneous recovery and association with good outcome is well documented in stroke [17][18][19] although in comparison to this group of patients, previous studies included either only moderate 19 or very severe stroke. 19 The relationship between early improvement and outcome, across the range of stroke severity studied here, in patients within each clinical syndrome has not previously been documented.…”

“…6,17 We therefore dichotomised patients into 'improvers' and 'non-improvers', dependent on their rate of recovery at day 4, and the recovery patterns of these sub-groups were distinct from one another. Furthermore, early improvement was significantly associated with a good outcome.…”