From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., E.K., O.B., L.R.)
School of Population and Global Health, University of Melbourne, Australia (N.R.S.)
Stroke. 2018 Dec;49(12):3081-3084. doi: 10.1161/STROKEAHA.118.022808.
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.
背景与目的-常用于评估蛛网膜下腔出血（aSAH）后功能预后的工具存在局限性。先前有研究提出，患者在出院后返家的时间可作为衡量缺血性脑卒中预后的有效指标。在此，我们旨在验证 aSAH 患者出院后返家时间作为预后指标的有效性。方法-我们对瑞士一家三级神经外科中心纳入的 aSAH 患者进行了前瞻性、多中心登记研究（瑞士 SOS [瑞士蛛网膜下腔出血研究]；2009-2015 年），并收集了相关数据。我们使用线性回归模型计算了每个改良 Rankin 量表（mRS）类别出院时和 1 年随访时的平均返家时间（定义为 aSAH 后 90 天内在家的天数）和 95%置信区间（CI）。结果-共纳入 1076 例患者（57.7%）的返家时间数据，其余 790 例患者的数据通过多重插补进行填补。出院时和 1 年随访时，返家时间随 mRS 评分的改善而增加（P<0.0001）。在参与的 8 家医院中，返家时间与 mRS 之间的关系均保持一致。结论-aSAH 后 90 天内的返家时间是一种可靠且易于确定的预后指标，可很好地区分患者出院时和 1 年随访时的不同恢复水平。该指标符合以患者为中心的现代医疗保健和研究趋势，代表了对患者特别重要的预后结果。
