Outcome and upper extremity function within 72 hours after first occasion of stroke in an unselected population at a stroke unit. A part of the SALGOT study

Abstract

BackgroundReduced upper extremity function is one of the most common impairments after stroke and has previously been reported in approximately 70-80% of patients in the acute stage. Acute care for stroke has changes over the last years, with more people being admitted to a stroke unit as well as use of thrombolysis. The aim of the present study was to describe baseline characteristics, care pathway and discharge status in an unselected group of patients with first occasion of stroke who were at a stroke unit within 72 hours after stroke and also to investigate the frequency of impaired arm and hand function. A second aim was to explore factors associated with impaired upper extremity function and the impact of impairment on the patient’s outcome.MethodsPatients over 18 years of age with first ever stroke, living in a geographical catchment area, being at the stroke unit within 72 hours after onset, with no prior upper extremity impairment were included. Baseline characteristics, arm and hand function within 72 hours, stroke outcome and care pathway in the acute phase were described, by gathering information retrospectively from the patients’ charts. Ischemic strokes were categorized according to the Bamford classification and the Trial of Org 10172 in Acute Stroke Treatment criteria.ResultsOf the 969 patients with first ever stroke who were screened, 642 patients fulfilled the inclusion criteria. According to the National Institutes of Health Stroke Scale (NIHSS), the patients had a mean score of 6.0, median 3.0, at arrival to the hospital. Ischemic stroke was most frequent in the anterior circulation (87.7%). Within 72 hours after stroke onset 48.0% of the patients had impaired arm and hand function and this was positively associated with higher age (p < 0.004), longer stay in the acute care (p < 0.001) and mortality in acute care (p < 0.001). Directly admitted to the stroke unit were 89.1% of the patients and 77.1% received hospital care on same day as stroke onset. Mean length of stay in the stroke unit was 9.9 days, 56.8% of the patients were discharged directly home from the stroke unit. Mortality within 72 hours after stroke onset was 5.0%.ConclusionImpaired arm and hand function is present in 48% of the patients in a non selected population with first ever stroke, estimated within 72 hours after onset. This is less than previously reported. Impaired arm and hand function early after stroke is associated with higher age, longer stay in the acute care, and higher mortality within the acute hospital care.

Upper-Limb Spasticity During the First Year After Stroke

“…The higher prevalence of spasticity in the present study may reflect this study's inclusion of all patients with arm paresis at day 3 and the absence of other disease-specific exclusions. Persson et al 2 found that 48% of the total population at a stroke unit had reduced arm function. Because upper-limb spasticity is uncommon in patients with normal arm function, and almost all patients with spasticity have some degree of spasticity in the upper-limb, 10 it may be reasonable to assume that 20%Y25% of all patients with a first stroke will develop upper-limb spasticity during the first year.…”

“…1 Recently, however, a lower prevalence (48%) of arm paresis on hospital admission has been noted. 2 The clinical features of stroke may be categorized as positive (e.g., spasticity) or negative (e.g., muscle weakness). The most commonly used definition of spasticity was proposed by Lance 3 : Bspasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflexes, as one component of the upper motor neuron syndrome.…”

Stroke treated at a neurosurgical ward: a cohort study

“…1). At the same time period, there were 642 with stroke who were admitted to at the stroke unit (all from the same catchment region, which has been presented elsewhere (14). This means 4.2% of the stroke population needed neurosurgical care.…”

“…All patients with first-time stroke at Sahlgrenska University Hospital between February 2009 and December 2010 were identified (as part of the SALGOT study (13,14)), and all who were treated at the neurosurgical department were included. As common, those admitted to neurosurgery were those where a surgical intervention was discussed and where the possible benefits were considered greater than the risk of harming.…”

“…The GCS quantifies motor responsiveness, verbal performance and eye movements independently, combining for a total score between 3 and 15 (15,16), which can be classified into mild (13)(14)(15), moderate (9-12) and severe (3)(4)(5)(6)(7)(8) (21). To assess the degree of disability or dependence in daily activities, the mRS was used (scores 0-6, where 0 is no symptoms and 6 is dead) (17).…”