| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 1999;30:2008-2012.)
© 1999 American Heart Association, Inc.
Original Contributions |
What Determines Good Recovery in Patients With the Most Severe Strokes?
The Copenhagen Stroke Study
From the Department of Neurology, Bispebjerg Hospital, and Department of Neurology, Gentofte Hospital (T.S.O.), Copenhagen, Denmark.
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 <15 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 
50 points) were
compared with the 58 survivors (69%) with a poor functional
outcome (Barthel Index <50 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; P=0.04), a spouse (OR, 3.1; 95% CI, 1.1 to 8.8; P=0.03), decreasing body temperature on admission (OR, 1.8 per 1°C decrease; 95% CI, 1.1 to 3.1; P=0.01), 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; P=0.01) 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.
Key Words: neuropsychological tests • outcome • prognosis • stroke
This article has been cited by other articles:
 |
|
 |
|
  S. F. Tyson, M. Hanley, J. Chillala, A. B. Selley, and R. C. Tallis The Relationship Between Balance, Disability, and Recovery After Stroke: Predictive Validity of the Brunel Balance Assessment Neurorehabil Neural Repair, July 1, 2007; 21(4): 341 - 346. [Abstract] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Holloway, C. G. Benesch, W. S. Burgin, and J. B. Zentner Prognosis and Decision Making in Severe Stroke JAMA, August 10, 2005; 294(6): 725 - 733. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. M.S. Nys, M. J.E. van Zandvoort, P. L.M. de Kort, H. B. van der Worp, B. P.W. Jansen, A. Algra, E. H.F. de Haan, and L. J. Kappelle The prognostic value of domain-specific cognitive abilities in acute first-ever stroke Neurology, March 8, 2005; 64(5): 821 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Audebert, M. M. Rott, T. Eck, and R. L. Haberl Systemic Inflammatory Response Depends on Initial Stroke Severity but Is Attenuated by Successful Thrombolysis Stroke, September 1, 2004; 35(9): 2128 - 2133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Askim, G Rohweder, S Lydersen, and B Indredavik Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial Clinical Rehabilitation, March 1, 2004; 18(3): 238 - 248. [Abstract] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
D. Schlegel;, S. J. Kolb, J. M. Luciano, J. M. Tovar, B. L. Cucchiara, D. S. Liebeskind, and S. E. Kasner Utility of the NIH Stroke Scale as a Predictor of Hospital Disposition Stroke, January 1, 2003; 34(1): 134 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. A. Copen, L. H. Schwamm, R. G. Gonzalez, O. Wu, C. B. Harmath, P. W. Schaefer, W. J. Koroshetz, and A. G. Sorensen Ischemic Stroke: Effects of Etiology and Patient Age on the Time Course of the Core Apparent Diffusion Coefficient Radiology, October 1, 2001; 221(1): 27 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Baer and S. L. Wolf Modified Emory Functional Ambulation Profile : An Outcome Measure for the Rehabilitation of Poststroke Gait Dysfunction Stroke, April 1, 2001; 32(4): 973 - 979. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Predictors of Good Outcome in Patients with the Most Severe Stroke Journal Watch Neurology, March 1, 2000; 2000(301): 5 - 5. [Full Text]
|
|