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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)

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.

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Correspondence to Pedro Navarrete-Navarro.

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An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-003-1840-x)

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Navarrete-Navarro, P., Rivera-Fernández, R., López-Mutuberría, M.T. et al. 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). Intensive Care Med 29, 1237–1244 (2003). https://doi.org/10.1007/s00134-003-1755-6

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  • DOI: https://doi.org/10.1007/s00134-003-1755-6

Keywords

  • Acute stroke
  • Apache III
  • Functional outcome
  • Disability
  • Mortality