Erschienen in:
01.08.2003 | Original
Outcome prediction in terms of functional disability and mortality at 1 year among ICU-admitted severe stroke patients: a prospective epidemiological study in the south of the European Union (Evascan Project, Andalusia, Spain)
verfasst von:
Pedro Navarrete-Navarro, Ricardo Rivera-Fernández, Maria Teresa López-Mutuberría, Inmaculada Galindo, Francisco Murillo, José María Dominguez, Angeles Muñoz, José Manuel Jimenez-Moragas, Belén Nacle, Guillermo Vázquez-Mata
Erschienen in:
Intensive Care Medicine
|
Ausgabe 8/2003
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Abstract
Objectives
To analyse 1-year mortality and functional disability outcomes and resource use in critical stroke patients admitted to ICU.
Design and setting
Multi-centre, prospective, observational study in 28 Spanish hospitals.
Patients
Patients admitted for acute stroke from March–August 1999.
Intervention
Collection of data on: severity by Apache III and Glasgow Coma Score; neurological lesion, hospital and 1-year mortality; functional disability at 1 year by Barthel Index and Glasgow Outcome Scale; ICU length of stay, life support techniques, and neurosurgical interventions.
Measurement and results
We studied 132 patients: 21% with subarachnoid haemorrhage (SAH), 58% intracerebral haemorrhage (ICH), 20% ischaemic stroke (ISC); Apache III 63±29 ICU stay 13±12 days; 74% required mechanical ventilation. Hospital and 1-year mortality was 33% (22%:ISC, 32%:SAH, 37%:ICH) and 53.8% (66%:ISC, 39%:SAH, 54%:ICH), respectively. Age, APACHE III, and diagnosis defined hospital mortality. Age, APACHE III, and Glasgow Coma Score defined 1-year mortality. Barthel Index score improved (P<0.001) between discharge and 1 year; 73% of patients presented severe disability at discharge vs. 26% at 1 year; 8% minimal/no disability at discharge vs. 43.3% at 1 year. Only 17% of subarachnoid haemorrhage patients presented severe disability at 1 year. Admission Apache III and hospital-discharge Barthel Index scores were related to functional outcome at 1 year.
Conclusions
Critical stroke patients are characterized by high severity of illness, elevated resource consumption, and poor outcomes that are mainly influenced by severity and age. Glasgow Coma Score-measured neurological severity is the main determinant of future functional capacity, which is greater at 1 year.