What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke study
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. We included the 223 patients (19%) with the most severe strokes (Scandinavian Stroke Scale score /=50 points) were...
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| Veröffentlicht in: | Stroke (1970) 1999-10, Vol.30 (10), p.2008-2012 |
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| container_end_page | 2012 |
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| container_issue | 10 |
| container_start_page | 2008 |
| container_title | Stroke (1970) |
| container_volume | 30 |
| creator | JØRGENSEN, H. S REITH, J NAKAYAMA, H KAMMERSGAARD, L. P RAASCHOU, H. O OLSEN, T. S |
| description | 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.
We included the 223 patients (19%) with the most severe strokes (Scandinavian Stroke Scale score /=50 points) were compared with the 58 survivors (69%) with a poor functional outcome (Barthel Index |
| doi_str_mv | 10.1161/01.STR.30.10.2008 |
| format | Article |
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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.
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 degrees 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.
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.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.30.10.2008</identifier><identifier>PMID: 10512899</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Biological and medical sciences ; Demography ; Denmark ; Female ; Humans ; Logistic Models ; Male ; Medical sciences ; Multivariate Analysis ; Neurology ; Prognosis ; Risk Factors ; Socioeconomic Factors ; Stroke - therapy ; Treatment Outcome ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 1999-10, Vol.30 (10), p.2008-2012</ispartof><rights>1999 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Oct 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-53724830b946e238cc74ccdba3da5037be7aed9a048b8fb42f5cf407c88003a13</citedby><cites>FETCH-LOGICAL-c390t-53724830b946e238cc74ccdba3da5037be7aed9a048b8fb42f5cf407c88003a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1976598$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10512899$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>JØRGENSEN, H. S</creatorcontrib><creatorcontrib>REITH, J</creatorcontrib><creatorcontrib>NAKAYAMA, H</creatorcontrib><creatorcontrib>KAMMERSGAARD, L. P</creatorcontrib><creatorcontrib>RAASCHOU, H. O</creatorcontrib><creatorcontrib>OLSEN, T. S</creatorcontrib><title>What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke study</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>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.
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.
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 degrees 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.
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.</description><subject>Biological and medical sciences</subject><subject>Demography</subject><subject>Denmark</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Multivariate Analysis</subject><subject>Neurology</subject><subject>Prognosis</subject><subject>Risk Factors</subject><subject>Socioeconomic Factors</subject><subject>Stroke - therapy</subject><subject>Treatment Outcome</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkN9rFDEQx4NY7LX6B_giQcS3PSc_dpM8STm0CgXBnvgYstnZ3tbbzZlkLfffm_MOLH0aZubz_TLzJeQ1gyVjDfsAbHm7_r4UpYUlB9DPyILVXFay4fo5WQAIU3FpzDm5SOkeALjQ9QtyzqBmXBuzIP7nxmXaYcY4DhMmehdCRyP68Afjng4T3bk84JQTfRjyhuYN0jGkTBMWAGnKMfzC9JGuy2IVdjht3B1O9PbfvKznbv-SnPVum_DVqV6SH58_rVdfqptv119XVzeVFwZyVQvFpRbQGtlgOdR7Jb3vWic6V4NQLSqHnXEgdav7VvK-9r0E5bUujzomLsn7o-8uht8zpmzHIXncbt2EYU5WgRaNZryAb5-A92GOU7nNMqO0bARXBWJHyMeQUsTe7uIwuri3DOwhfgvMlvitgMPkEH_RvDkZz-2I3SPFMe8CvDsBLnm37aOb_JD-c0Y1tdHiL2LgjaA</recordid><startdate>19991001</startdate><enddate>19991001</enddate><creator>JØRGENSEN, H. S</creator><creator>REITH, J</creator><creator>NAKAYAMA, H</creator><creator>KAMMERSGAARD, L. P</creator><creator>RAASCHOU, H. O</creator><creator>OLSEN, T. S</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>19991001</creationdate><title>What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke study</title><author>JØRGENSEN, H. S ; REITH, J ; NAKAYAMA, H ; KAMMERSGAARD, L. P ; RAASCHOU, H. O ; OLSEN, T. S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-53724830b946e238cc74ccdba3da5037be7aed9a048b8fb42f5cf407c88003a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Biological and medical sciences</topic><topic>Demography</topic><topic>Denmark</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Multivariate Analysis</topic><topic>Neurology</topic><topic>Prognosis</topic><topic>Risk Factors</topic><topic>Socioeconomic Factors</topic><topic>Stroke - therapy</topic><topic>Treatment Outcome</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>JØRGENSEN, H. S</creatorcontrib><creatorcontrib>REITH, J</creatorcontrib><creatorcontrib>NAKAYAMA, H</creatorcontrib><creatorcontrib>KAMMERSGAARD, L. P</creatorcontrib><creatorcontrib>RAASCHOU, H. O</creatorcontrib><creatorcontrib>OLSEN, T. S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>JØRGENSEN, H. S</au><au>REITH, J</au><au>NAKAYAMA, H</au><au>KAMMERSGAARD, L. P</au><au>RAASCHOU, H. O</au><au>OLSEN, T. S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke study</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>1999-10-01</date><risdate>1999</risdate><volume>30</volume><issue>10</issue><spage>2008</spage><epage>2012</epage><pages>2008-2012</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>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.
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.
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 degrees 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.
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>10512899</pmid><doi>10.1161/01.STR.30.10.2008</doi><tpages>5</tpages></addata></record> |
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| ispartof | Stroke (1970), 1999-10, Vol.30 (10), p.2008-2012 |
| issn | 0039-2499 1524-4628 |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Biological and medical sciences Demography Denmark Female Humans Logistic Models Male Medical sciences Multivariate Analysis Neurology Prognosis Risk Factors Socioeconomic Factors Stroke - therapy Treatment Outcome Vascular diseases and vascular malformations of the nervous system |
| title | What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke study |
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