Deans' stroke musings: Clinical Predictors of Survival and Functional Outcome of Stroke Patients Admitted to Critical Care

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, June 23, 2018

Clinical Predictors of Survival and Functional Outcome of Stroke Patients Admitted to Critical Care

Who gives a fuck about predictions? Survivors want results you blithering idiots, 100% recovery. What are you doing to solve all the problems in stroke? Are you that fucking stupid you don't even know what to research? All because we have NO stroke leadership and NO stroke strategy.
https://journals.lww.com/ccmjournal/Abstract/2018/07000/Clinical_Predictors_of_Survival_and_Functional.7.aspx

van Valburg, Mariëlle K., MD¹; Arbous, M. Sesmu, MD, PhD^2,3; Georgieva, Milena, MD, EDA, EDIC, AFICM⁴; Brealey, David A., PhD, MECP, FRCA⁵; Singer, Mervyn, MB, BS, MD, FRCP, FRCP(Edin), FFICM⁵; Geerts, Bart F., MD, PhD, MSc⁶

Critical Care Medicine: July 2018 - Volume 46 - Issue 7 - p 1085–1092

doi: 10.1097/CCM.0000000000003127

Clinical Investigations

Objectives: To determine the predictive value of commonly used clinical variables upon ICU admission for long-term all-cause mortality and functional outcome of adult stroke patients admitted to the ICU.

Design: Retrospective observational cohort study.

Setting: General and neurosurgical ICUs of the University College London Hospitals in North Central London.

Patients: All adult ICU patients with a clinical diagnosis of acute stroke admitted between February 2010 and May 2012.

Interventions: None.

Measurements and Main Results: Demographic and clinical data concerning the first 24 hours after ICU admission were obtained. Patients were followed until February 2016 to assess long-term survival. Functional outcome was determined using the modified Rankin Scale. We evaluated 131 critically ill stroke patients, with a median (interquartile range) age of 70 years (55–78 yr). One-year mortality rate was 52.7%. Surviving patients were followed up over a median (interquartile range) period of 4.3 years (4.0–4.8 yr). The multivariable model that best predicted long-term all-cause mortality indicated that mortality of critically ill stroke patients was predicted by high Acute Physiology and Chronic Health Evaluation II score, impaired consciousness (Glasgow Coma Scale score ≤ 8) as reason for ICU admission, low Glasgow Coma Scale sum score after 24 hours, and absence of brainstem reflexes. Long-term independent functional status occurred in 30.9% of surviving patients and was predicted by low Acute Physiology and Chronic Health Evaluation II score, high Glasgow Coma Scale sum score at ICU admission, and absence of mass effect on CT scan.

Conclusions: Mortality in critically ill stroke patients is high and occurs most often shortly after the event. Less than one in three surviving patients is able to function independently after 1 year. This study has identified several clinical variables that predict long-term all-cause mortality and functional outcome among critically ill stroke patients and found that mainly acute physiologic disturbance and absolute values of neurologic clinical assessment are predictive.