Boehme Amelia K, Martin-Schild Sheryl, Marshall Randolph S, Lazar Ronald M
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.
Neurology. 2016 Nov 29;87(22):2348-2354. doi: 10.1212/WNL.0000000000003297. Epub 2016 Oct 7.
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.
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.
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).
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.
确定失语症对急性脑卒中住院期间预后的独立影响，同时控制美国国立卫生院卒中量表（NIHSS）总分及意识丧失情况。
使用2008年7月至2014年12月杜兰大学卒中登记处的数据，内容包括患者人口统计学资料、NIHSS评分、住院时间（LOS）、并发症（脓毒症、深静脉血栓形成）以及出院时改良Rankin量表（mRS）评分。失语症定义为入院时NIHSS第9项评分>1分，偏瘫定义为第5或6项评分>1分。
在1847例患者中，866例（46%）入院时有失语症。在对NIHSS评分和住院并发症进行校正后，失语症患者的住院时间比无失语症患者长1.22天，而偏瘫患者（n = 1225）与无偏瘫患者相比，住院时间并未增加。失语症患者发生并发症的几率（优势比[OR] 1.44，置信区间[CI] 1.07 - 1.93，p = 0.0174）高于无失语症患者，这与偏瘫患者相当（OR 1.47，CI 1.09 - 1.99，p = 0.0137）。在控制NIHSS评分后，失语症患者出院时mRS评分为3 - 6分的几率更高（OR 1.42对1.15）。
失语症与急性脑卒中住院期间住院时间延长和并发症增加独立相关，每年给美国急性脑卒中护理增加21.6亿美元费用。与偏瘫相比，失语症的存在更有可能导致功能预后不良。这些数据表明，有必要进一步研究确定建立适应性沟通技能是否能减轻其在急性脑卒中情况下的后果。
