title: Effect of aphasia on acute stroke outcomes.
abstract: OBJECTIVE
  To determine the independent effects of aphasia on outcomes during acute stroke admission, controlling for total NIH Stroke Scale (NIHSS) scores and loss of consciousness.
  
  
  METHODS
  Data from the Tulane Stroke Registry were used from July 2008 to December 2014 for patient demographics, NIHSS scores, length of stay (LOS), complications (sepsis, deep vein thrombosis), and discharge modified Rankin Scale (mRS) score. Aphasia was defined as a score >1 on question 9 on the NIHSS on admission and hemiparesis as >1 on questions 5 or 6.
  
  
  RESULTS
  Among 1,847 patients, 866 (46%) had aphasia on admission. Adjusting for NIHSS score and inpatient complications, those with aphasia had a 1.22 day longer LOS than those without aphasia, whereas those with hemiparesis (n = 1,225) did not have any increased LOS compared to those without hemiparesis. Those with aphasia had greater odds of having a complication (odds ratio [OR] 1.44, confidence interval [CI] 1.07-1.93, p = 0.0174) than those without aphasia, which was equivalent to those having hemiparesis (OR 1.47, CI 1.09-1.99, p = 0.0137). Controlling for NIHSS scores, aphasia patients had higher odds of discharge mRS 3-6 (OR 1.42 vs 1.15).
  
  
  CONCLUSIONS
  Aphasia is independently associated with increased LOS and complications during the acute stroke admission, adding $2.16 billion annually to US acute stroke care. The presence of aphasia was more likely to produce a poor functional outcome than hemiparesis. These data suggest that further research is necessary to determine whether establishing adaptive communication skills can mitigate its consequences in the acute stroke setting.
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (A.K.B., R.S.M., R.M.L.), and Department of Epidemiology, Mailman School of Public Health (A.K.B.), Columbia University, New York, NY; and Comprehensive Stroke Center (S. M.-S.), Department of Neurology, Tulane School of Medicine, New Orleans, LA. ral22@columbia.edu.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Lazar
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000209:etiology* / Q000628:therapy*; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000150:complications / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D014474:Unconsciousness / Q000150:complications / Q000628:therapy; D014481:United States; D055815:Young Adult