Solomon N A, Glick H A, Russo C J, Lee J, Schulman K A
Robert Wood Johnson Clinical Scholars Program, Stanford University School of Medicine, Palo Alto, Calif.
Stroke. 1994 Sep;25(9):1721-5. doi: 10.1161/01.str.25.9.1721.
In clinical trials stroke is reported as a major morbid outcome, but the impact of stroke on patients is not directly assessed. This study examines patient preferences for different outcomes of stroke, including death.
We presented patients with written case scenarios of stroke outcomes. The scenarios represented four categories of stroke severity (mild, moderate, severe, and fatal), and for nonfatal strokes the scenarios described motor, language, and cognitive deficits. Patients reported values for each of the 10 stroke scenarios using a rank-and-scale method over a 100-point range, with 100 representing perfect health and 0 corresponding to the worst possible health state.
One hundred seventeen of 209 consecutive patients at risk for stroke participated in this study. Severe strokes were uniformly rated as having low preference weights (mean +/- SD [median]: 3 +/- 4 [1] for disabling hemiplegia, 8 +/- 9 [5] for confusion, and 15 +/- 14 [10] for global aphasia), and severe motor impairment (a disabling hemiplegia) was rated as significantly worse than death. Even mild deficits resulted in substantial loss to patients (54 +/- 21 [55] for dysarthria and 53 +/- 21 [50] for mild anomia).
Strokes may result in a wide variety of post-stroke consequences for patients. Severe strokes may be viewed by patients as tantamount to or worse than death. Even mild strokes may cause significant declines in patient preferences for health states. These data are useful in interpreting studies that report stroke and death, in designing new studies that measure stroke in at-risk populations, and in helping patients reach treatment decisions about therapies designed to prevent strokes.
在临床试验中，中风被报告为主要的不良结局，但中风对患者的影响并未得到直接评估。本研究探讨了患者对中风不同结局（包括死亡）的偏好。
我们向患者展示了中风结局的书面病例场景。这些场景代表了四类中风严重程度（轻度、中度、重度和致命性），对于非致命性中风，场景描述了运动、语言和认知缺陷。患者使用排名和量表方法对10个中风场景中的每一个在100分范围内进行评分，100分代表完美健康，0分对应最差的健康状态。
209名连续的中风高危患者中有117名参与了本研究。严重中风的偏好权重均被评为较低（平均±标准差[中位数]：偏瘫致残为3±4[1]，意识模糊为8±9[5]，完全性失语为15±14[10]），严重运动障碍（偏瘫致残）被评为比死亡更严重。即使是轻微的缺陷也会给患者带来巨大损失（构音障碍为54±21[55]，轻度命名性失语为53±21[50]）。
中风可能给患者带来各种各样的中风后后果。患者可能认为严重中风等同于死亡或比死亡更糟。即使是轻微中风也可能导致患者对健康状态的偏好显著下降。这些数据有助于解释报告中风和死亡的研究，有助于设计针对高危人群测量中风的新研究，也有助于帮助患者做出关于预防中风治疗的决策。
