In:
Neurocritical Care, Springer Science and Business Media LLC, Vol. 38, No. 1 ( 2023-02), p. 138-148
Abstract:
Despite improvements in the critical care management of subarachnoid hemorrhage (SAH), a substantial number of patients still suffer from disabilities. In most areas of the world, longitudinal follow-up is not routinely performed, and the patient’s trajectory remains unknown. Methods We prospectively collected data of 298 consecutive patients with spontaneous SAH and evaluated clinical trajectories at discharge, 3 months, and 1 year after SAH. In a subgroup of patients transferred to a local neurorehabilitation center (Rehab-Hochzirl), we studied the effects of rehabilitation intensity on clinical trajectories. Any decrease in the modified Rankin Scale (mRS) was defined as an improvement, with mRS ≤ 2 indicating good outcome. We used multivariate generalized linear models to investigate associations with clinical trajectories. Results Out of the 250 surviving patients, 35% were transferred directly to Rehab-Hochzirl ( n = 87 of 250; mRS at discharge = 4), 11% were transferred to another rehabilitation center ( n = 27 of 250; mRS = 1), 1% were transferred to a nursing home ( n = 3 of 250; mRS = 5), 21% were transferred to their country of origin ( n = 52 of 250; mRS = 4), and 32% ( n = 79 of 250; mRS = 1) were discharged home. Functional outcome improved in 57% ( n = 122 of 215) of patients during the first 3 months, with an additional 16% (35 of 215) improving between 3 and 12 months, resulting in an overall improvement in 73% ( n = 157 of 215) of survivors. After 1 year, 60% ( n = 179 of 250) of patients were functionally independent. A lower Hunt and Hess scale score at intensive care unit admission, younger age, a lower mRS at intensive care unit discharge, fewer days on mechanical ventilation, and male sex were independently associated with better functional recovery. Although the subgroup of patients transferred to Rehab-Hochzirl were more severely affected, 60% (52 of 87) improved during inpatient neurorehabilitation. Conclusions Our results indicate ongoing functional improvement in a substantial number of patients with SAH throughout a follow-up period of 12 months. This effect was also observed in patients with severe disability receiving inpatient neurorehabilitation.
Type of Medium:
Online Resource
ISSN:
1541-6933
,
1556-0961
DOI:
10.1007/s12028-022-01572-6
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2023
detail.hit.zdb_id:
2176033-0
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