Which variables help explain the poor health-related quality of life after subarachnoid hemorrhage? A meta-analysis.
OBJECTIVE
Patients with subarachnoid hemorrhage (SAH) are younger than typical stroke patients. Poor psychosocial outcome after SAH therefore leads to a disproportionately high impact on patients, relatives, and society. Addressing this problem requires an understanding of what causes poor psychosocial outcome. Numerous studies have examined potential predictors but produced conflicting results. We aim to resolve this uncertainty about the potential value of individual predictors by conducting a meta-analysis. This approach allows us to quantitatively combine the findings from all relevant studies to identify promising predictors of psychosocial outcome and determine the strength with which those predictors are associated with measures of psychosocial health.


METHODS
Psychosocial health was measured by health-related quality of life (HRQOL). We included in our analysis those predictors that were most frequently examined in this context, namely patient age, sex, neurologic state at the time of hospital admission, bleed severity, physical disability, cognitive impairment, and time between ictus and psychosocial assessment.


RESULTS
Only 1 of the traditional variables, physical disability, had any notable affect on HRQOL. Therefore, the cause of most HRQOL impairment after SAH remains unknown. The situation is even worse for mental HRQOL, an area that is often significantly affected in SAH patients. Here, 90% of the variance remains unexplained by traditional predictors.


CONCLUSIONS
Studies need to turn to new factors to account for poor patient outcome.
Noble
Adam J
AJ
Institute of Psychiatry, King's College London, London, United Kingdom.
Schenk
Thomas
T
D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D006304:Health Status; D006801:Humans; D017063:Outcome Assessment, Health Care; D011203:Poverty; D011788:Quality of Life; D012720:Severity of Illness Index; D012919:Social Behavior; D012959:Socioeconomic Factors; D013345:Subarachnoid Hemorrhage / Q000523:psychology*; D011795:Surveys and Questionnaires