Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation

Anna Lindner; Luca Brunelli; Verena Rass; Bogdan-Andrei Ianosi; Max Gaasch; Mario Kofler; Victoria Limmert; Alois J. Schiefecker; Bettina Pfausler; Ronny Beer; Elke Pucks-Faes; Raimund Helbok

doi:10.1007/s12028-022-01572-6

journal article Open Access Aug 12, 2022

Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation

Anna Lindner Luca Brunelli Verena Rass Bogdan-Andrei Ianosi Max Gaasch Mario Kofler Victoria Limmert Alois J. Schiefecker Bettina Pfausler Ronny Beer Elke Pucks-Faes Raimund Helbok

Neurocritical Care Vol. 38 No. 1 pp. 138-148 · Springer Science and Business Media LLC

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Abstract

AbstractBackgroundDespite improvements in the critical care management of subarachnoid hemorrhage (SAH), a substantial number of patients still suffer from disabilities. In most areas of the world, longitudinal follow-up is not routinely performed, and the patient’s trajectory remains unknown.MethodsWe prospectively collected data of 298 consecutive patients with spontaneous SAH and evaluated clinical trajectories at discharge, 3 months, and 1 year after SAH. In a subgroup of patients transferred to a local neurorehabilitation center (Rehab-Hochzirl), we studied the effects of rehabilitation intensity on clinical trajectories. Any decrease in the modified Rankin Scale (mRS) was defined as an improvement, with mRS ≤ 2 indicating good outcome. We used multivariate generalized linear models to investigate associations with clinical trajectories.ResultsOut of the 250 surviving patients, 35% were transferred directly to Rehab-Hochzirl (n = 87 of 250; mRS at discharge = 4), 11% were transferred to another rehabilitation center (n = 27 of 250; mRS = 1), 1% were transferred to a nursing home (n = 3 of 250; mRS = 5), 21% were transferred to their country of origin (n = 52 of 250; mRS = 4), and 32% (n = 79 of 250; mRS = 1) were discharged home. Functional outcome improved in 57% (n = 122 of 215) of patients during the first 3 months, with an additional 16% (35 of 215) improving between 3 and 12 months, resulting in an overall improvement in 73% (n = 157 of 215) of survivors. After 1 year, 60% (n = 179 of 250) of patients were functionally independent. A lower Hunt and Hess scale score at intensive care unit admission, younger age, a lower mRS at intensive care unit discharge, fewer days on mechanical ventilation, and male sex were independently associated with better functional recovery. Although the subgroup of patients transferred to Rehab-Hochzirl were more severely affected, 60% (52 of 87) improved during inpatient neurorehabilitation.ConclusionsOur results indicate ongoing functional improvement in a substantial number of patients with SAH throughout a follow-up period of 12 months. This effect was also observed in patients with severe disability receiving inpatient neurorehabilitation.

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References

40

[1]

van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124:249–78. 10.1093/brain/124.2.249

[2]

Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28:660–4. 10.1161/01.str.28.3.660

[3]

Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8:635–42. 10.1016/s1474-4422(09)70126-7

[4]

Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8:355–69. 10.1016/s1474-4422(09)70025-0

[5]

Cognitive and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Timour Al-Khindi, R. Loch Macdonald, Tom A. Schweizer

Stroke 2010 10.1161/strokeaha.110.581975

[6]

Robba C, Sonneville R, Meyfroidt G. Focus on neuro-critical care: combined interventions to improve relevant outcomes. Intensive Care Med. 2020;46:1027–9. 10.1007/s00134-020-06014-5

[7]

Mart MF, Pun BT, Pandharipande P, Jackson JC, Ely EW. ICU survivorship—the relationship of delirium, sedation, dementia, and acquired weakness. Crit Care Med. 2021;49:1227–40. 10.1097/ccm.0000000000005125

[8]

Guidelines for Adult Stroke Rehabilitation and Recovery

Carolee J. Winstein, Joel Stein, Ross Arena et al.

Stroke 2016 10.1161/str.0000000000000098

[9]

Inter-individual Variability in the Capacity for Motor Recovery After Ischemic Stroke

Shyam Prabhakaran, Eric Zarahn, Claire Riley et al.

Neurorehabilitation and Neural Repair 2008 10.1177/1545968307305302

[10]

Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35:93–112. 10.1159/000346087

[11]

Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43:1711–37. 10.1161/str.0b013e3182587839

[12]

Surgical Risk as Related to Time of Intervention in the Repair of Intracranial Aneurysms

William E. Hunt, Robert M. Hess

Journal of Neurosurgery 1968 10.3171/jns.1968.28.1.0014

[13]

Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006;59:21–7 (discussion-7).

[14]

Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1–9. 10.1227/00006123-198001000-00001

[15]

Definition of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage as an Outcome Event in Clinical Trials and Observational Studies

Mervyn D.I. Vergouwen, Marinus Vermeulen, Jan van Gijn et al.

Stroke 2010 10.1161/strokeaha.110.589275

[16]

Freimuller M, Fheodoroff K. Neurorehabilitation after stroke. Wien Med Wochenschr. 2003;153:25–8. 10.1046/j.1563-258x.2003.02110.x

[17]

Organization WH. IFC: International Classification of Functioning, disability and health. 2001.

[18]

Gadidi V, Katz-Leurer M, Carmeli E, Bornstein NM. Long-term outcome poststroke: predictors of activity limitation and participation restriction. Arch Phys Med Rehabil. 2011;92:1802–8. 10.1016/j.apmr.2011.06.014

[19]

Wang H, Sandel ME, Terdiman J, et al. Postacute care and ischemic stroke mortality: findings from an integrated health care system in northern California. PM R. 2011;3:686–94. 10.1016/j.pmrj.2011.04.028

[20]

Spontaneous subarachnoid haemorrhage

R Loch Macdonald, Tom A Schweizer

The Lancet 2017 10.1016/s0140-6736(16)30668-7

[21]

Wilson DA, Nakaji P, Albuquerque FC, McDougall CG, Zabramski JM, Spetzler RF. Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design. J Neurosurg. 2013;119:606–12. 10.3171/2013.4.jns121287

[22]

Stabel HH, Pedersen AR, Johnsen SP, Nielsen JF. Functional independence: a comparison of the changes during neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage and patients with intracerebral hemorrhage or acute ischemic stroke. Arch Phys Med Rehabil. 2017;98:759–65. 10.1016/j.apmr.2016.11.010

[23]

Altuntas O, Tas S, Cetin A. An investigation of the factors that influence functional improvement in stroke rehabilitation. Turk J Med Sci. 2021;51:1448–54. 10.3906/sag-2101-94

[24]

Lofgren B, Nyberg L, Osterlind PO, Gustafson Y. In-patient rehabilitation after stroke: outcome and factors associated with improvement. Disabil Rehabil. 1998;20:55–61. 10.3109/09638289809166054

[25]

Rhie SH, Choi JW, Jeon SJ, Kang SD, Joo MC, Kim MS. Characteristics of patients with aneurysmal subarachnoid hemorrhage and risk factors related to dysphagia. Ann Rehabil Med. 2016;40:1024–32. 10.5535/arm.2016.40.6.1024

[26]

Dunn K, Rumbach A. Incidence and risk factors for dysphagia following non-traumatic subarachnoid hemorrhage: a retrospective cohort study. Dysphagia. 2019;34:229–39. 10.1007/s00455-018-9934-3

[27]

Keser T, Kofler M, Katzmayr M, et al. Risk factors for dysphagia and the impact on outcome after spontaneous subarachnoid hemorrhage. Neurocrit Care. 2020;33:132–9. 10.1007/s12028-019-00874-6

[28]

Dziewas R, Stellato R, van der Tweel I, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol. 2018;17:849–59. 10.1016/s1474-4422(18)30255-2

[29]

Frontera JA, Fernandez A, Schmidt JM, et al. Impact of nosocomial infectious complications after subarachnoid hemorrhage. Neurosurgery. 2008;62:80–7 (discussion 7). 10.1227/01.neu.0000311064.18368.ea

[30]

Lindner A, Kofler M, Rass V, et al. Early predictors for infectious complications in patients with spontaneous intracerebral hemorrhage and their impact on outcome. Front Neurol. 2019;10:817. 10.3389/fneur.2019.00817

[31]

Gittler M, Davis AM. Guidelines for adult stroke rehabilitation and recovery. JAMA. 2018;319:820–1. 10.1001/jama.2017.22036

[32]

Maier M, Ballester BR, Verschure P. Principles of neurorehabilitation after stroke based on motor learning and brain plasticity mechanisms. Front Syst Neurosci. 2019;13:74. 10.3389/fnsys.2019.00074

[33]

Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hearing Res JSLHR. 2008;51:S225–39. 10.1044/1092-4388(2008/018)

[34]

Kwakkel G. Impact of intensity of practice after stroke: issues for consideration. Disabil Rehabil. 2006;28:823–30. 10.1080/09638280500534861

[35]

Coleman ER, Moudgal R, Lang K, et al. Early rehabilitation after stroke: a narrative review. Curr Atheroscler Rep. 2017;19:59. 10.1007/s11883-017-0686-6

[36]

Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin. 2017;33:225–43. 10.1016/j.ccc.2016.12.005

[37]

Der Tiroler Tourismus - Zahlen, Daten und Fakten 2021. 2021. https://www.tirolwerbung.at/tiroler-tourismus/zahlen-und-fakten-zum-tiroler-tourismus. Accessed 26 May 2022.

[38]

Steyerberg EW, Wiegers E, Sewalt C, et al. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol. 2019;18:923–34. 10.1016/s1474-4422(19)30232-7

[39]

Savio K, Pietra GL, Oddone E, Reggiani M, Leone MA. Reliability of the modified Rankin Scale applied by telephone. Neurol Int. 2013;5: e2. 10.4081/ni.2013.e2

[40]

Janssen PM, Visser NA, Dorhout Mees SM, Klijn CJ, Algra A, Rinkel GJ. Comparison of telephone and face-to-face assessment of the modified Rankin Scale. Cerebrovasc Dis. 2010;29:137–9. 10.1159/000262309

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Details

Published: Aug 12, 2022
Vol/Issue: 38(1)
Pages: 138-148
License: View

Authors

Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

B

Bogdan-Andrei Ianosi

Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria; Neurology, Clinical Research Institute of Neuroscience, Johannes Kepler University Linz, Kepler University Hospital, Linz, Linz, Austria

Funding

University of Innsbruck and Medical University of Innsbruck

Cite This Article

Anna Lindner, Luca Brunelli, Verena Rass, et al. (2022). Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation. Neurocritical Care, 38(1), 138-148. https://doi.org/10.1007/s12028-022-01572-6

Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation

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