Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen stroke study

Abstract

Objective: To evaluate the outcome of stroke stratified according to both initial stroke severity and initial level of disability. Design: Prospective, consecutive, and community based. Setting: A stroke unit of a hospital in Denmark. This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the City of Copenhagen. Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age, stroke severity, and premorbid condition. Patients: 1197 patients with acute stroke. Main Outcome Measures: Primary outcome was measured as death, discharge to nursing home, or to own home. Secondary outcome was measured as neurological deficits and functional disabilities after completed rehabilitation and again 6 months after stroke onset, using the Scandinavian Neurological Stroke Scale and the Barthel Index. Results: Stroke was initially very severe in 223 (19%) of the patients, severe in 171 (14%), moderate in 316 (26%), and mild in 487 (41%) patients. Two hundred and fifty (21%) patients died during hospital stay, 177 (15%) were discharged to nursing home, and 770 (64%) patients were discharged to their own home. After completed rehabilitation, 11% of survivors still had severe or very severe neurological deficits, 11% had moderate deficits, and 78% had no or only mild deficits; 20% were severely or very severely disabled, 8% were moderately disabled, 26% were mildly disabled, and 46% had no disability in activities of daily living. Detailed information on outcome stratified according to initial stroke severity/disability also is presented. Conclusions: This study provides a thorough description of the needs for stroke rehabilitation in the community and the amount of postrehabilitation disability in stroke survivors. For outcome prediction, the results can be used as a reliable tool for prognostication of the chances (or risks) of various outcomes in patients characterized by initial degree of stroke severity and/or functional disability using simple, reliable scores in the acute phase of stroke. However, the results should not be used as a guideline for selecting patients for rehabilitation in the acute phase because even the most severe cases regularly experience meaningful improvement during rehabilitation.