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Long-Term Outcomes of Patients with Stroke Predicted by Clinicians to have no Chance of Meaningful Recovery: A Japanese Cohort Study

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Abstract

Background

Little is known about the natural history of comatose patients with brain injury, as in many countries most of these patients die in the context of withdrawal of life-sustaining therapies (WLSTs). The accuracy of predicting recovery that is used to guide goals-of-care decisions is uncertain. We examined long-term outcomes of patients with ischemic or hemorrhagic stroke predicted by experienced clinicians to have no chance of meaningful recovery in Japan, where WLST in patients with isolated neurological disease is uncommon.

Methods

We retrospectively reviewed the medical records of all patients admitted with acute ischemic stroke, intracerebral hemorrhage, or nontraumatic subarachnoid hemorrhage between January 2018 and December 2020 to a neurocritical care unit at Toda Medical Group Asaka Medical Center in Saitama, Japan. We screened for patients who were predicted by the attending physician on postinjury day 1–4 to have no chance of meaningful recovery. Primary outcome measures were disposition at hospital discharge and the ability to follow commands and functional outcomes measured by the Glasgow Outcome Scale-Extended (GOS-E), which was assessed 6 months after injury.

Results

From 860 screened patients, we identified 40 patients (14 with acute ischemic stroke, 19 with intracerebral hemorrhage, and 7 with subarachnoid hemorrhage) who were predicted to have no chance of meaningful recovery. Median age was 77 years (interquartile range 64–85), 53% (n = 21) were women, and 80% (n = 32) had no functional deficits prior to hospitalization. Six months after injury, 17 patients were dead, 14 lived in a long-term care hospital, 3 lived at home, 2 lived in a rehabilitation center, and 2 lived in a nursing home. Three patients reliably followed commands, two were in a vegetative state (GOS-E 2), four fully depended on others and required constant assistance (GOS-E 3), one could be left alone independently for 8 h per day but remained dependent (GOS-E 4), and one was independent and able to return to work-like activities (GOS-E 5).

Conclusions

In the absence of WLST, almost half of the patients predicted shortly after the injury to have no chance of meaningful recovery were dead 6 months after the injury. A small minority of patients had good functional recovery, highlighting the need for more accurate neurological prognostication.

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Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Hammond FM, Katta-Charles S, Russell MB, et al. Research needs for prognostic modeling and trajectory analysis in patients with disorders of consciousness. Neurocrit Care. 2021;35(Suppl 1):55–67. https://doi.org/10.1007/s12028-021-01289-y.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke. 2003;34(7):1717–22. https://doi.org/10.1161/01.STR.0000078657.22835.B9.

    Article  PubMed  Google Scholar 

  3. Flint AC, Cullen SP, Faigeles BS, Rao VA. Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score. AJNR Am J Neuroradiol. 2010;31(7):1192–6. https://doi.org/10.3174/ajnr.A2050.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–7. https://doi.org/10.1161/01.str.32.4.891.

    Article  PubMed  Google Scholar 

  5. Myint PK, Clark AB, Kwok CS, et al. The SOAR (stroke subtype, oxford community stroke project classification, age, prestroke modified Rankin) score strongly predicts early outcomes in acute stroke. Int J Stroke. 2014;9(3):278–83. https://doi.org/10.1111/ijs.12088.

    Article  PubMed  Google Scholar 

  6. Rost NS, Smith EE, Chang Y, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008;39(8):2304–9. https://doi.org/10.1161/STROKEAHA.107.512202.

    Article  PubMed  Google Scholar 

  7. Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, Padilla-Martinez JJ, Gonzalez-Cornejo S. Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke. 2007;38(5):1641–4. https://doi.org/10.1161/STROKEAHA.106.478222.

    Article  PubMed  Google Scholar 

  8. Saposnik G, Kapral MK, Liu Y, et al. IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke. Circulation. 2011;123(7):739–49. https://doi.org/10.1161/CIRCULATIONAHA.110.983353.

    Article  PubMed  Google Scholar 

  9. Sembill JA, Gerner ST, Volbers B, et al. Severity assessment in maximally treated ICH patients: The max-ICH score. Neurology. 2017;89(5):423–31. https://doi.org/10.1212/WNL.0000000000004174.

    Article  PubMed  Google Scholar 

  10. Strbian D, Meretoja A, Ahlhelm FJ, et al. Predicting outcome of IV thrombolysis-treated ischemic stroke patients: the DRAGON score. Neurology. 2012;78(6):427–32. https://doi.org/10.1212/WNL.0b013e318245d2a9.

    Article  CAS  PubMed  Google Scholar 

  11. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20. https://doi.org/10.3171/jns.1968.28.1.0014.

    Article  CAS  PubMed  Google Scholar 

  12. Alotaibi NM, Elkarim GA, Samuel N, et al. Effects of decompressive craniectomy on functional outcomes and death in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2017;127(6):1315–25. https://doi.org/10.3171/2016.9.JNS161383.

    Article  PubMed  Google Scholar 

  13. Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ. Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg. 1990;72(4):559–66. https://doi.org/10.3171/jns.1990.72.4.0559.

    Article  CAS  PubMed  Google Scholar 

  14. Brandecker S, Hadjiathanasiou A, Kern T, Schuss P, Vatter H, Guresir E. Primary decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage: long-term outcome in a single-center study and systematic review of literature. Neurosurg Rev. 2021;44(4):2153–62. https://doi.org/10.1007/s10143-020-01383-3.

    Article  PubMed  Google Scholar 

  15. Macdonald RL. Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol. 2014;10(1):44–58. https://doi.org/10.1038/nrneurol.2013.246.

    Article  CAS  PubMed  Google Scholar 

  16. Zhao B, Rabinstein A, Murad MH, Lanzino G, Panni P, Brinjikji W. Surgical and endovascular treatment of poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg Sci. 2017;61(4):403–15. https://doi.org/10.23736/S0390-5616.16.03457-3.

    Article  PubMed  Google Scholar 

  17. Witsch J, Frey HP, Patel S, et al. Prognostication of long-term outcomes after subarachnoid hemorrhage: The FRESH score. Ann Neurol. 2016;80(1):46–58. https://doi.org/10.1002/ana.24675.

    Article  PubMed  Google Scholar 

  18. Lee DH, Cho YS, Lee BK, et al. Late awakening is common in settings without withdrawal of life-sustaining therapy in out-of-hospital cardiac arrest survivors who undergo targeted temperature management. Crit Care Med. 2022;50(2):235–44. https://doi.org/10.1097/CCM.0000000000005274.

    Article  PubMed  Google Scholar 

  19. Rohaut B, Claassen J. Decision making in perceived devastating brain injury: a call to explore the impact of cognitive biases. Br J Anaesth. 2018;120(1):5–9. https://doi.org/10.1016/j.bja.2017.11.007.

    Article  CAS  PubMed  Google Scholar 

  20. Elmer J, Torres C, Aufderheide TP, et al. Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 2016;102:127–35. https://doi.org/10.1016/j.resuscitation.2016.01.016.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Turgeon AF, Lauzier F, Simard JF, et al. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ. 2011;183(14):1581–8. https://doi.org/10.1503/cmaj.101786.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Steinberg A, Abella BS, Gilmore EJ, et al. Frequency of withdrawal of life-sustaining therapy for perceived poor neurologic prognosis. Crit Care Explor. 2021;3(7): e0487. https://doi.org/10.1097/CCE.0000000000000487.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Alkhachroum A, Bustillo AJ, Asdaghi N, et al. Withdrawal of life-sustaining treatment mediates mortality in patients with intracerebral hemorrhage with impaired consciousness. Stroke. 2021;52(12):3891–8. https://doi.org/10.1161/STROKEAHA.121.035233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Asai A, Maekawa M, Akiguchi I, et al. Survey of Japanese physicians’ attitudes towards the care of adult patients in persistent vegetative state. J Med Ethics. 1999;25(4):302–8. https://doi.org/10.1136/jme.25.4.302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Yaguchi A, Truog RD, Curtis JR, et al. International differences in end-of-life attitudes in the intensive care unit: results of a survey. Arch Intern Med. 2005;165(17):1970–5. https://doi.org/10.1001/archinte.165.17.1970.

    Article  PubMed  Google Scholar 

  26. Makino J, Fujitani S, Twohig B, Krasnica S, Oropello J. End-of-life considerations in the ICU in Japan: ethical and legal perspectives. J Intensive Care. 2014;2(1):9. https://doi.org/10.1186/2052-0492-2-9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. The Japanese Society of Intensive Care Medicine EC. The current situation survey about the clinical ethics in the affiliation facilities of the Japanese society of intensive care medicine councilor. J Jpn Soc Intensive Care Med. 2013;20:307–19.

    Article  Google Scholar 

  28. (JSEPTIC) JSoPaTiIC. A brief survey for end-of-life. 2012 http://www.jseptic.com/rinsho/pdf/questionnaire_120125.pdf.

  29. Akabayashi A, Slingsby BT, Kai I. Perspectives on advance directives in Japanese society: a population-based questionnaire survey. BMC Med Ethics. 2003;4:E5. https://doi.org/10.1186/1472-6939-4-5.

    Article  PubMed  Google Scholar 

  30. Wilson JT, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998;15(8):573–85. https://doi.org/10.1089/neu.1998.15.573.

    Article  CAS  PubMed  Google Scholar 

  31. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–7. https://doi.org/10.1161/01.str.19.5.604.

    Article  PubMed  Google Scholar 

  32. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.

    Article  CAS  PubMed  Google Scholar 

  33. Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure: on behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med. 1996;22(7):707–10. https://doi.org/10.1007/BF01709751.

    Article  CAS  PubMed  Google Scholar 

  34. Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989;46(6):660–2. https://doi.org/10.1001/archneur.1989.00520420080026.

    Article  CAS  PubMed  Google Scholar 

  35. Wilson L, Boase K, Nelson LD, et al. A Manual for the Glasgow outcome scale-extended interview. J Neurotrauma. 2021;38(17):2435–46. https://doi.org/10.1089/neu.2020.7527.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fatima N, Razzaq S, El Beltagi A, Shuaib A, Saqqur M. Decompressive craniectomy: a preliminary study of comparative radiographic characteristics predicting outcome in malignant ischemic stroke. World Neurosurg. 2020;133:e267–74. https://doi.org/10.1016/j.wneu.2019.08.223.

    Article  PubMed  Google Scholar 

  37. Stienen MN, Visser-Meily JM, Schweizer TA, et al. Prioritization and timing of outcomes and endpoints after aneurysmal subarachnoid hemorrhage in clinical trials and observational studies: proposal of a multidisciplinary research group. Neurocrit Care. 2019;30(Suppl 1):102–13. https://doi.org/10.1007/s12028-019-00737-0.

    Article  PubMed  Google Scholar 

  38. Chen KY, Kung WM, Kuo LT, Huang AP. Ultrarapid endoscopic-aided hematoma evacuation in patients with thalamic hemorrhage. Behav Neurol. 2021;2021:8886004. https://doi.org/10.1155/2021/8886004.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I: conceptual framework and item selection. Med Care. 1992;30(6):473–83.

    Article  PubMed  Google Scholar 

  40. Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, Trojano L. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. 2010;75(3):239–45. https://doi.org/10.1212/WNL.0b013e3181e8e8cc.

    Article  CAS  PubMed  Google Scholar 

  41. Hammond FM, Giacino JT, Nakase Richardson R, et al. Disorders of consciousness due to traumatic brain injury: functional status ten years post-injury. J Neurotrauma. 2019;36(7):1136–46. https://doi.org/10.1089/neu.2018.5954.

    Article  PubMed  Google Scholar 

  42. Katz DI, Polyak M, Coughlan D, Nichols M, Roche A. Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up. Prog Brain Res. 2009;177:73–88. https://doi.org/10.1016/S0079-6123(09)17707-5.

    Article  PubMed  Google Scholar 

  43. Nakase-Richardson R, Whyte J, Giacino JT, et al. Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs. J Neurotrauma. 2012;29(1):59–65. https://doi.org/10.1089/neu.2011.1829.

    Article  PubMed  Google Scholar 

  44. Whyte J, Nakase-Richardson R, Hammond FM, et al. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil. 2013;94(10):1855–60. https://doi.org/10.1016/j.apmr.2012.10.041.

    Article  PubMed  Google Scholar 

  45. Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56(6):766–72. https://doi.org/10.1212/wnl.56.6.766.

    Article  CAS  PubMed  Google Scholar 

  46. Velly L, Perlbarg V, Boulier T, et al. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol. 2018;17(4):317–26. https://doi.org/10.1016/S1474-4422(18)30027-9.

    Article  PubMed  Google Scholar 

  47. Claassen J, Doyle K, Matory A, et al. Detection of brain activation in unresponsive patients with acute brain injury. N Engl J Med. 2019;380(26):2497–505. https://doi.org/10.1056/NEJMoa1812757.

    Article  PubMed  Google Scholar 

  48. Edlow BL, Chatelle C, Spencer CA, et al. Early detection of consciousness in patients with acute severe traumatic brain injury. Brain. 2017;140(9):2399–414. https://doi.org/10.1093/brain/awx176.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kondziella D, Menon DK, Helbok R, et al. A precision medicine framework for classifying patients with disorders of consciousness: advanced classification of consciousness endotypes (ACCESS). Neurocrit Care. 2021;35(Suppl 1):27–36. https://doi.org/10.1007/s12028-021-01246-9.

    Article  PubMed  Google Scholar 

  50. Muehlschlegel S, Goostrey K, Flahive J, Zhang Q, Pach JJ, Hwang DY. A pilot randomized clinical trial of a goals-of-care decision aid for surrogates of severe acute brain injury patients. Neurology. 2022. https://doi.org/10.1212/WNL.0000000000200937.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Muehlschlegel S, Hwang DY, Flahive J, et al. Goals-of-care decision aid for critically ill patients with TBI: development and feasibility testing. Neurology. 2020;95(2):e179–93. https://doi.org/10.1212/WNL.0000000000009770.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Evans LR, Boyd EA, Malvar G, et al. Surrogate decision-makers’ perspectives on discussing prognosis in the face of uncertainty. Am J Respir Crit Care Med. 2009;179(1):48–53. https://doi.org/10.1164/rccm.200806-969OC.

    Article  PubMed  Google Scholar 

  53. White DB, Ernecoff N, Buddadhumaruk P, et al. Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically Ill patients. JAMA. 2016;315(19):2086–94. https://doi.org/10.1001/jama.2016.5351.

    Article  CAS  PubMed  Google Scholar 

  54. Zier LS, Burack JH, Micco G, et al. Doubt and belief in physicians’ ability to prognosticate during critical illness: the perspective of surrogate decision makers. Crit Care Med. 2008;36(8):2341–7. https://doi.org/10.1097/CCM.0b013e318180ddf9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wagner AK. TBI rehabilomics research: an exemplar of a biomarker-based approach to precision care for populations with disability. Curr Neurol Neurosci Rep. 2017;17(11):84. https://doi.org/10.1007/s11910-017-0791-5.

    Article  PubMed  Google Scholar 

  56. Muehlschlegel S, Shutter L, Col N, Goldberg R. Decision aids and shared decision-making in neurocritical care: an unmet need in our NeuroICUs. Neurocrit Care. 2015;23(1):127–30. https://doi.org/10.1007/s12028-014-0097-2.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We express our sincere thanks to Nestor Serrano for translating the medical record notes from Japanese into English (Supplemental Fig. 3). I would confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.

Funding

JC is supported by grant funding from the National Institutes of Health (NS106014, R03 NS112760). SE is supported by a grant from Toda Medical Group Asaka Medical Center.

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Author notes

  1. Satoshi Egawa and Jeremy Ader contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA

    Satoshi Egawa, Jeremy Ader, Qi Shen, Kevin Doyle, Lauren Grobois, Athina Vrosgou, Jerina C. Carmona, Angela Velazquez, Shivani Ghoshal, David Roh, Sachin Agarwal, Soojin Park & Jan Claassen

  2. Department of Neurointensive Care, Toda Medical Group Asaka Medical Center, Saitama, Japan

    Satoshi Egawa, Shun Nakagawa, Yoshihisa Fujimoto & Shuichi Fujii

  3. Department of Neurosurgery, Stroke and Epilepsy Center, Toda Medical Group Asaka Medical Center, Saitama, Japan

    Satoshi Egawa, Satoru Miyao & Hidetoshi Nakamoto

  4. Department of Rehabilitation, Toda Medical Group Asaka Medical Center, Saitama, Japan

    Kenta Masuda, Akira Shirota, Masafumi Ota & Yuji Yoshino

  5. Department of Social Work, Toda Medical Group Asaka Medical Center, Saitama, Japan

    Hitomi Amai

  6. Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan

    Yasuhiro Kuroda

  7. Department of Biomedical Informatics, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA

    Soojin Park

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Contributions

SE, JA, and JC wrote the article. SE, SN, YF, SF, KM, AS, MO, YY, HA, SM, and HN were involved in data collection. QS performed data analysis. All authors contributed a critical and final revision of the article. The final manuscript was approved by all authors.

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Correspondence to Jan Claassen.

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For this retrospective and prospective analysis, we sought approval from the ethics committee of the Toda Medical Group Asaka Medical Center (institutional review board [IRB]) to conduct this study (IRB 21-07). The IRB approved a waiver of participant consent for the retrospective review. For the prospective assessment of patient outcomes, we did obtain consent from the patient whenever possible and from the surrogate decision-maker if patients were unable to provide consent.

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Egawa, S., Ader, J., Shen, Q. et al. Long-Term Outcomes of Patients with Stroke Predicted by Clinicians to have no Chance of Meaningful Recovery: A Japanese Cohort Study. Neurocrit Care 38, 733–740 (2023). https://doi.org/10.1007/s12028-022-01644-7

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