Functional outcome after common poststroke complications occurring in the first 90 days.
OBJECTIVE
The aim of this study was to explore the associations of common medical complications with functional outcome at 90 days post stroke.


METHODS
Patients with unselected acute stroke were included and observed for 16 predefined complications during the first week. Fifty percent (244 patients) were allocated to follow-up of 13 complications until 90 days and then assessed with the modified Rankin Scale 90. Common complications were defined as complications with frequencies of ≥5%. Ordinal logistic regression (worsened outcome), as well as binary logistic regression for severe dependency and death (modified Rankin Scale score>3) was performed.


RESULTS
Seven of the 13 complications occurred at a frequency ≥5%. Recurrent stroke and chest infection were found to have an odds ratio for worsened outcome of 7.45 (95% confidence interval, 2.83-20.96; P<0.0001) and 3.28 (95% confidence interval, 1.16-9.29; P=0.025), respectively. Infections other than chest infections and urinary tract infections had an odds ratio for worsened outcome of 1.59 (95% confidence interval, 1.12-2.24; P=0.009) and falls an odds ratio of 1.43 (95% confidence interval, 1.06 to 1.93; P=0.021). Myocardial infarction, urinary tract infections, and pain were not associated with a worsened outcome in terms of modified Rankin Scale 90.


CONCLUSIONS
Recurrent stroke and chest infections were strongly associated with a worsened outcome. Other infections and falls were associated with less worsening. For myocardial infarction, urinary tract infections, and pain no association with functional outcome was found. Active strategies for prevention and early treatment of the first 2 complications seem advisable; patient monitoring as part of comprehensive stroke unit care should ensure timely identification and treatment of all complications.
From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. gitta.rohweder@ntnu.no.
Gitta
G
Rohweder
From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Hanne
H
Ellekjær
From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Øyvind
Ø
Salvesen
From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Eirik
E
Naalsund
From the Stroke Unit, Department of Internal Medicine, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway (G.R., H.E., E.N., B.I.); and Department of Neuroscience (G.R., B.I.) and Unit for Applied Clinical Research (Ø.S.), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Bent
B
Indredavik
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D010146:Pain / Q000150:complications; D003668:Pressure Ulcer / Q000150:complications; D011655:Pulmonary Embolism / Q000150:complications; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000150:complications*; D012640:Seizures / Q000150:complications; D013223:Statistics as Topic; D020521:Stroke / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications*; D020246:Venous Thrombosis / Q000150:complications
complications; patient outcome assessment; stroke; stroke unit