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.

• Authors: Martin Nikolaus Stienen, Nicolas Roydon Smoll, Christian Fung, Johannes Goldberg, David Bervini, Rodolfo Maduri, Alessio Chiappini, Thomas Robert, Adrien May, Philippe Bijlenga, Daniel Zumofen, Michel Roethlisberger, Martin Alexander Seule, Serge Marbacher, Javier Fandino, Bawarjan Schatlo, Karl Schaller, Emanuela Keller, Oliver Bozinov, Luca Regli, Swiss SOS Study Group
• Journal: Stroke (Stroke) Vol. 49 Issue 12 Pg. 3081-3084 (12 2018) ISSN: 1524-4628 [Electronic] United States
• PMID: 30735342 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aneurysm, Ruptured (physiopathology)
• Female
• Humans
• Independent Living (statistics & numerical data)
• Intracranial Aneurysm (physiopathology)
• Linear Models
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Patient Discharge
• Residence Characteristics (statistics & numerical data)
• Subarachnoid Hemorrhage (physiopathology)
• Time Factors