(Stroke. 1996;27:415-420.)
© 1996 American Heart Association, Inc.
Articles |
Complications After Acute Stroke
From the Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland.
Correspondence to R.J. Davenport, Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, Scotland EH4 2XU. E-mail rjd@skull.dcn.edinburgh.ec.uk.
Background and Purpose We sought to observe the type, timing, and frequency of complications occurring in hospitalized patients after an acute stroke.
Methods In a single hospital, we prospectively identified a consecutive cohort of patients who were either admitted after an acute stroke or who suffered a stroke while already an inpatient (n=613). We retrieved the case notes for 607 (99%) of these strokes, and a single observer, using predefined diagnostic criteria, reviewed the notes and recorded the type, timing, and frequency of complications that occurred during the inpatient period. We also measured the reliability of complication identification from case note review by comparing two observers on a sample of records.
Results Complications were recorded after 360 strokes (59%); the most common individual complications were falls (complicating 22% of all strokes), skin breaks (18%), and urinary tract (16%) or chest (12%) infections. Miscellaneous "other" complications complicated 32% of strokes. Seizures and chest infections occurred early, whereas depression and painful shoulder were later problems. Complications were more common in older patients, who were more disabled before their stroke and had suffered more severe strokes. We demonstrated moderate to good agreement between the two observers for most complications.
Conclusions Complications after acute stroke are common, confirming that stroke rehabilitation requires active and knowledgeable medical input. Knowing the nature and timing of complications, together with the identification of high-risk patients, may be useful to those planning stroke services. The differences in our results and those previously reported, most notably for skin breaks, are probably due to the different methods used, in particular patient selection and diagnostic criteria for complications. Although complications may be useful as a measure of outcome in comparative studies (eg, therapeutic trials and audit), the methodological difficulties in accurately and reliably measuring them must be addressed.
Key Words: complications • stroke, acute • stroke rehabilitation
This article has been cited by other articles:
 |
|
 |
|
  D.J. Stott, A. Falconer, H. Miller, J.C. Tilston, and P. Langhorne Urinary tract infection after stroke QJM, April 1, 2009; 102(4): 243 - 249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Eriksson, E.-L. Glader, B. Norrving, A. Terent, and B. Stegmayr Sex Differences in Stroke Care and Outcome in the Swedish National Quality Register for Stroke Care Stroke, March 1, 2009; 40(3): 909 - 914. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Czernuszenko and A. Czlonkowska Risk factors for falls in stroke patients during inpatient rehabilitation Clinical Rehabilitation, February 1, 2009; 23(2): 176 - 188. [Abstract] [PDF]
|
|
|
|
|
|
R. Aquilani, M. Scocchi, P. Iadarola, P. Franciscone, M. Verri, F. Boschi, E. Pasini, and S. Viglio Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke Clinical Rehabilitation, December 1, 2008; 22(12): 1042 - 1050. [Abstract] [PDF]
|
|
|
|
|
|
C. Sackley, N. Brittle, S. Patel, J. Ellins, M. Scott, C. Wright, and M. E. Dewey The Prevalence of Joint Contractures, Pressure Sores, Painful Shoulder, Other Pain, Falls, and Depression in the Year After a Severely Disabling Stroke Stroke, December 1, 2008; 39(12): 3329 - 3334. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Molnar, A Peterfalvi, L Szereday, G Pusch, L Szapary, S Komoly, L Bogar, and Z Illes Deficient leucocyte antisedimentation is related to post-stroke infections and outcome J. Clin. Pathol., November 1, 2008; 61(11): 1209 - 1213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Nelson, M. A. Smith, B. C. Martinson, A. Kind, and R. V. Luepker Declining Patient Functioning and Caregiver Burden/Health: The Minnesota Stroke Survey-Quality of Life After Stroke Study Gerontologist, October 1, 2008; 48(5): 573 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Hilz and S. Schwab Stroke-Induced Sudden-Autonomic Death: Areas of Fatality Beyond the Insula Stroke, September 1, 2008; 39(9): 2421 - 2422. [Full Text] [PDF]
|
|
|
|
|
|
B. Indredavik, G. Rohweder, E. Naalsund, and S. Lydersen Medical Complications in a Comprehensive Stroke Unit and an Early Supported Discharge Service Stroke, February 1, 2008; 39(2): 414 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.K. Myint, K.E.S. Poole, and E.A. Warburton Hip fractures after stroke and their prevention QJM, September 1, 2007; 100(9): 539 - 545. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Roquer, A. Ois, A. Rodriguez-Campello, M. Gomis, E. Munteis, J. Jimenez-Conde, E. Cuadrado-Godia, and J. E. Martinez-Rodriguez Atherosclerotic Burden and Early Mortality in Acute Ischemic Stroke Arch Neurol, May 1, 2007; 64(5): 699 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rocco, M. Pasquini, E. Cecconi, G. Sirimarco, M. C. Ricciardi, E. Vicenzini, M. Altieri, V. Di Piero, and G. L. Lenzi Monitoring After the Acute Stage of Stroke: A Prospective Study Stroke, April 1, 2007; 38(4): 1225 - 1228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, X. Urra, and A. M. Planas Infection After Acute Ischemic Stroke: A Manifestation of Brain-Induced Immunodepression Stroke, March 1, 2007; 38(3): 1097 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Gee, A. Kalil, C. Shea, and K. J. Becker Lymphocytes: Potential Mediators of Postischemic Injury and Neuroprotection Stroke, February 1, 2007; 38(2): 783 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ryvlin, A. Montavont, and N. Nighoghossian Optimizing therapy of seizures in stroke patients Neurology, December 26, 2006; 67(12_suppl_4): S3 - S9. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. Dutta, T. Wood, R. Thomas, and M. Asrar ul Haq Is overnight tube feeding associated with hypoxia in stroke? Age Ageing, November 1, 2006; 35(6): 627 - 629. [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Navarini, M. Recher, K. S. Lang, P. Georgiev, S. Meury, A. Bergthaler, L. Flatz, J. Bille, R. Landmann, B. Odermatt, et al. Increased susceptibility to bacterial superinfection as a consequence of innate antiviral responses PNAS, October 17, 2006; 103(42): 15535 - 15539. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Singh and S Hamdy Dysphagia in stroke patients. Postgrad. Med. J., June 1, 2006; 82(968): 383 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Smith, A. Forster, and J. Young Use of the 'STRATIFY' falls risk assessment in patients recovering from acute stroke Age Ageing, March 1, 2006; 35(2): 138 - 143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Vargas, J. P. Horcajada, V. Obach, M. Revilla, A. Cervera, F. Torres, A. M. Planas, J. Mensa, and A. Chamorro Clinical Consequences of Infection in Patients With Acute Stroke: Is It Prime Time for Further Antibiotic Trials? Stroke, February 1, 2006; 37(2): 461 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-J. Bae, D.-S. Yoon, J. Lee, B.-K. Kim, J.-S. Koo, O. Kwon, and J.-M. Park In-Hospital Medical Complications and Long-Term Mortality After Ischemic Stroke Stroke, November 1, 2005; 36(11): 2441 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, J.P. Horcajada, V. Obach, M. Vargas, M. Revilla, F. Torres, A. Cervera, A.M. Planas, and J. Mensa The Early Systemic Prophylaxis of Infection After Stroke Study: A Randomized Clinical Trial Stroke, July 1, 2005; 36(7): 1495 - 1500. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Dennis Effective Prophylaxis for Deep Vein Thrombosis After Stroke: Low-Dose Anticoagulation Rather Than Stockings Alone: Against Stroke, December 1, 2004; 35(12): 2912 - 2913. [Full Text] [PDF]
|
|
|
|
 |
|
 P. U. Heuschmann, P. L. Kolominsky-Rabas, B. Misselwitz, P. Hermanek, C. Leffmann, R. W. C. Janzen, J. Rother, H.-J. Buecker-Nott, K. Berger, and for The German Stroke Registers Study Group Predictors of In-Hospital Mortality and Attributable Risks of Death After Ischemic Stroke: The German Stroke Registers Study Group Arch Intern Med, September 13, 2004; 164(16): 1761 - 1768. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Meisel, K. Prass, J. Braun, I. Victorov, T. Wolf, D. Megow, E. Halle, H.-D. Volk, U. Dirnagl, and A. Meisel Preventive Antibacterial Treatment Improves the General Medical and Neurological Outcome in a Mouse Model of Stroke Stroke, January 1, 2004; 35(1): 2 - 6. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cavallini, G. Micieli, S. Marcheselli, and S. Quaglini Role of Monitoring in Management of Acute Ischemic Stroke Patients Stroke, November 1, 2003; 34(11): 2599 - 2603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Roffe, S. Sills, M. Halim, K. Wilde, M. B. Allen, P. W. Jones, and P. Crome Unexpected Nocturnal Hypoxia in Patients With Acute Stroke Stroke, November 1, 2003; 34(11): 2641 - 2645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Prass, C. Meisel, C. Hoflich, J. Braun, E. Halle, T. Wolf, K. Ruscher, I. V. Victorov, J. Priller, U. Dirnagl, et al. Stroke-induced Immunodeficiency Promotes Spontaneous Bacterial Infections and Is Mediated by Sympathetic Activation Reversal by Poststroke T Helper Cell Type 1-like Immunostimulation J. Exp. Med., September 2, 2003; 198(5): 725 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Vernino, R. D. Brown Jr, J. J. Sejvar, J. D. Sicks, G. W. Petty, and W. M. O'Fallon Cause-Specific Mortality After First Cerebral Infarction: A Population-Based Study Stroke, August 1, 2003; 34(8): 1828 - 1832. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hilker, C. Poetter, N. Findeisen, J. Sobesky, A. Jacobs, M. Neveling, and W.-D. Heiss Nosocomial Pneumonia After Acute Stroke: Implications for Neurological Intensive Care Medicine Stroke, April 1, 2003; 34(4): 975 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. L. Katzan, R. D. Cebul, S. H. Husak, N. V. Dawson, and D. W. Baker The effect of pneumonia on mortality among patients hospitalized for acute stroke Neurology, February 25, 2003; 60(4): 620 - 625. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Roth, L. Lovell, R. L. Harvey, R. K. Bode, and A. W. Heinemann Stroke Rehabilitation: Indwelling Urinary Catheters, Enteral Feeding Tubes, and Tracheostomies Are Associated With Resource Use and Functional Outcomes Stroke, July 1, 2002; 33(7): 1845 - 1850. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. McPherson, D. Woo, P. L. Cohen, A. M. Pancioli, B. M. Kissela, J. A. Carrozzella, T. A. Tomsick, M. Zuccarello, and S. Chaturvedi Early Carotid Endarterectomy for Critical Carotid Artery Stenosis After Thrombolysis Therapy in Acute Ischemic Stroke in the Middle Cerebral Artery Editorial Comment Stroke, September 1, 2001; 32(9): 2075 - 2080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Roffe, S. Sills, K. Wilde, and P. Crome Effect of Hemiparetic Stroke on Pulse Oximetry Readings on the Affected Side Stroke, August 1, 2001; 32(8): 1808 - 1810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Roth, L. Lovell, R. L. Harvey, A. W. Heinemann, P. Semik, and S. Diaz Incidence of and Risk Factors for Medical Complications During Stroke Rehabilitation Stroke, February 1, 2001; 32(2): 523 - 529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kelly, A. Rudd, R. Lewis, and B. J. Hunt Venous Thromboembolism After Acute Stroke Stroke, January 1, 2001; 32(1): 262 - 267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Langhorne, D. J. Stott, L. Robertson, J. MacDonald, L. Jones, C. McAlpine, F. Dick, G. S. Taylor, and G. Murray Medical Complications After Stroke : A Multicenter Study Stroke, June 1, 2000; 31(6): 1223 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Stroke, April 1, 2000; 31(4): 1002 - 1012. [Full Text] [PDF]
|
|
|
|
 |
|
 Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Circulation, March 28, 2000; 101(12): 1483 - 1493. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Davenport and M. Dennis Neurological emergencies: acute stroke J. Neurol. Neurosurg. Psychiatry, March 1, 2000; 68(3): 277 - 288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. P. Gasecki, M. Eliasziw, and M. B. Pritz Timing of Carotid Endarterectomy After Stroke • Response Stroke, December 1, 1998; 29(12): 2667 - 2668. [Full Text] [PDF]
|
|
|
|
|
|
K. C. Johnston, J. Y. Li, P. D. Lyden, S. K. Hanson, T. E. Feasby, R. J. Adams, R. E. Faught Jr, and E. C. Haley Jr Medical and Neurological Complications of Ischemic Stroke : Experience From the RANTTAS Trial Stroke, February 1, 1998; 29(2): 447 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. B. Pritz Timing of Carotid Endarterectomy After Stroke Stroke, December 1, 1997; 28(12): 2563 - 2567. [Abstract] [Full Text]
|
|