Monitoring after the acute stage of stroke: a prospective study.
OBJECTIVE
In the early stage of stroke, the occurrence of neurologic and medical complications is associated with clinical deterioration. Previous studies were focused on the first week after stroke onset. The aim of this study was to evaluate the impact of complications on clinical outcome in patients with stroke in the early subacute stage.


METHODS
We prospectively evaluated the influence on the outcome of complications feasible (MC) and not feasible for monitoring (NMC) in all patients with stroke admitted consecutively in our subacute stroke unit. Patients were divided into three classes according to stroke severity evaluated by the National Institutes of Health Stroke Scale score. A change in the National Institutes of Health Stroke Scale score group from admission to discharge was considered clinically significant.


RESULTS
We included 261 patients. Sixty percent of patients had complications (105 MC, 118 NMC). Hyperthermia (OR=14.12; 95% CI: 6.01 to 33.20), urinary infections (OR=4.92; 95% CI: 2.19 to 11.04), hypertension (OR=2.86; 95% CI: 1.21 to 6.76), hypoxia (OR=15.75; 95% CI: 6.73 to 36.84), and neuroradiologic damage progression (OR=58.31; 95% CI, 19.48 to 174.55) were associated with a change to a more severe class at discharge and with a higher risk of mortality.


CONCLUSIONS
A high percentage of patients can develop both MC and NMC during this subacute stage of stroke. The occurrence of complications influences outcome and raises the question about the need for a prolonged stay in a dedicated ward for patients with stroke.
Rocco
Andrea
A
Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy. andrea.rocco@uniroma1.it
Pasquini
Marta
M
Cecconi
Emanuella
E
Sirimarco
Gaia
G
Ricciardi
Maria C
MC
Vicenzini
Edoardo
E
Altieri
Marta
M
Di Piero
Vittorio
V
Lenzi
Gian L
GL
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology; D000860:Hypoxia / Q000175:diagnosis / Q000453:epidemiology; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D009026:Mortality; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology