Prognostic indicators of the lack of a great functional improvement and sustained disability among in-patients with cerebral stroke who were managed in a Comprehensive Stroke Unit

Abstract

High-quality care may help reduce the severity of stroke consequences, but the optimal model of in-patient cerebral stroke care is not yet defi ned. The aim of the study was to determine the predictors of failing to achieve favorable functional outcome assessed with the Barthel index (BI) after treatment in the Comprehensive Stroke Unit (CSU). Patients with cerebral stroke, who were in 2010 to 2018 admitted to the Stroke Center — a multidisciplinary hospital unit that operates according to the CSU principles — were enrolled to the study. Patients’ data were prospectively entered into a special database and included baseline and fi nal assessments with neurological scales. If the BI total at discharge exceeded 60 or increased at least by 50 compared with baseline, the favorable outcome was considered achieved, otherwise — failed. Among 677 included in-patients, age 20 to 95 years, 271 (40.4 %) females, 80.8 % had an ischemic, and 19.2 % hemorrhagic cerebral stroke. The median NIHSS score at was 10. The onset to CSU hospitalization delay ranged from less 24 hours (17.5 % of the patients) to more than 180 days (17.2 % of the patients), and 59.7 % of the participants were admitted during the fi rst 30 days from the index stroke. In multivariate analysis, 7 indicators were strongly and independently linked with the risk for unfavourable functional outcome. The area under the operating characteristics curve (AUC = 0.93) indicates excellent consistency of the prediction model and the strong association of the predictors with the risk for a signifi cant need in help in ADLs. Independent predictors of functional insolvency can help better estimate the prognosis and optimize decision making on treatment strategy. Patient’s age, recurrent stroke, severity of the initial impairments and long delay to CSU admission has the most signifi cant infl uence on the risk for disability after discharge from CSU.