Home-Time as a Surrogate Marker for Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose— Commonly used tools to determine functional outcome after aneurysmal subarachnoid hemorrhage (aSAH) have limitations. Time spent at the patient’s home has previously been proposed as a robust outcome measure after ischemic stroke. Here, we set out to validate home-time as an outcome measure after aSAH. Methods— We examined prospectively collected data from a nationwide multicenter registry of aSAH patients admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009–2015). We calculated mean home-time (defined as days spent at home for the first 90 days after aSAH) and 95% CIs for each category of modified Rankin Scale at discharge and 1-year follow-up, using linear regression models to analyze home-time differences per modified Rankin Scale category. Results— We had home-time data from 1076 of 1866 patients (57.7%), and multiple imputation was used to fill-in missing data from the remaining 790 patients. Increasing home-time was associated with improved modified Rankin Scale scores at time of hospital discharge ( P <0.0001) and at 1-year follow-up ( P <0.0001). Within each of the 8 participating hospitals, the relationship between home-time and modified Rankin Scale was maintained. Conclusions— Home-time for the first 90 days after aSAH offers a robust and easily ascertainable outcome measure, discriminating particularly well across better recovery levels at time of hospital discharge and at 1-year follow-up. This measure complies with the modern trend of patient-centered healthcare and research, representing an outcome that is particularly relevant to the patient. Clinical Trial Registration— URL: https://clinicaltrials.gov . Unique identifier: NCT03245866.

Home-Time Is a Feasible and Valid Stroke Outcome Measure in National Datasets

“…The approach could be easily applied to other diseases and other time points. Use of HT following subarachnoid haemorrhage is described 13 , but the HT concept could be used beyond cerebrovascular disease allowing a 'big data' approach to other chronic conditions. 14…”

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

“…with the modified Rankin Scale or the Barthel Index. [11][12][13][14][15]36,39,40 Here, we demonstrate a strong correlation with another measure of functional status, the FIM, adding weight to the construct validity of 'home-time'. Total FIM and motor subscale scores were strongly associated with 'home-time', whereas the correlation between cognitive subscale scores and days spent at home was more moderate.…”

“…18 Comorbidities may be undernumerated as these are only coded if requiring treatment, although applying a look-back period reduces undernumeration. 42 The apparent protective effects of stroke his- Calculations of 'home-time' here and elsewhere [11][12][13][14][15] do not incorporate information on intermittent services, or the level of support required when daily services cease. However, such patients do not have high-level medical needs and are not required to stay in hospital, usually being discharged before intermittent services are in place.…”

“…'Home-time' measures the number of days spent at home after stroke onset, taking into account patient survival and days spent in hospital, reflecting a patient's capacity to return to their private residence after hospitalisation. [11][12][13][14][15] 'Home-time' therefore can be unobtrusively and objectively measured using routinely collected data that are linked to health records following stroke and is proposed as a patient-centred surrogate measure of functional status. 'Home-time' in stroke is often measured within 90 days of admission, [11][12][13][14][15] in keeping with the gold-standard follow-up period for clinical trials and epidemiological research.…”

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

“…During the hospital period following aSAH, the outcome of survivors is often evaluated only by functional grading scales such as the modified Ranking Scale (mRS) [4] or Glasgow Outcome Scale (GOS) [5]. Despite their advantages in terms of standardizing the outcome assessment, some criticism has been raised regarding their insensitivity to neuropsychological deficits (NPDs) [6][7][8]. In fact, NPDs are the most common form of disabilities after aSAH; nearly half of the independent patients suffer from these impairments, causing difficulties in activities of daily living (ADLs) and return to premorbid work [9][10][11].…”