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).
OBJECTIVE
To analyse 1-year mortality and functional disability outcomes and resource use in critical stroke patients admitted to ICU.


METHODS
Multi-centre, prospective, observational study in 28 Spanish hospitals. PATIENTS. Patients admitted for acute stroke from March-August 1999.


METHODS
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.


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.
Navarrete-Navarro
Pedro
P
Critical Care and Emergency Department, Virgen de las Nieves University Hospital, Hospital de Traumatologia, Carretera de Jaen s/n, 18014, Granada, Spain. pnavarro@ugr.es
Rivera-Fernández
Ricardo
R
López-Mutuberría
Maria Teresa
MT
Galindo
Inmaculada
I
Murillo
Francisco
F
Dominguez
José María
JM
Muñoz
Angeles
A
Jimenez-Moragas
José Manuel
JM
Nacle
Belén
B
Vázquez-Mata
Guillermo
G
D000368:Aged; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*; D016896:Treatment Outcome