Abstract 2694: Trajectory and Predictors of Functional Recovery after Subarachnoid Hemorrhage

Abstract

Background: SAH frequently causes severe disability or death. Although there are extensive data on predictors of survival after SAH, there are few data on the trajectory and predictors of functional recovery after hospital discharge. Methods: We prospectively gathered data from October 2009 to April 2010 on consecutive patients with non-traumatic SAH who survived to hospital discharge. Functional outcomes based on the modified Rankin Scale (mRS) score were calculated at discharge from chart review and at six months via a standardized telephone interview. Good functional status was defined as an mRS score of 0 to 2, and poor status as an mRS score of 3 to 6. Descriptive statistics were used to assess the trajectory of functional recovery from hospital discharge to 6 months, and ordinal logistic regression was used to identify clinical factors associated with recovery, defined as the difference between the 6-month and discharge mRS scores. Results: Sixty-six of 70 patients hospitalized with SAH during the study period had 6-month outcome data, and 53 (80%) survived to hospital discharge and were included in our analysis. Mean age was 54 (13) years, and 33 (62%) were women. Median (IQR) Hunt-Hess grade, Fisher score, and GCS at presentation were 2 (2-4), 3 (2-4), and 15 (9-15), respectively. SAH was due to aneurysms (79%), perimesencephalic hemorrhages (9%), and other causes (12%). Most patients were discharged home (70%). Median (IQR) mRS score was 3 (2-4) at discharge and 2 (1-2) at 6 months. Of the 29 patients with poor functional status at discharge, 16 (55%) improved to good functional status at 6 months ( Figure ). Patients had greater odds of improvement between their discharge and 6-month mRS scores if they were older (OR per decade 2.2, 95% CI 1.4-3.5), had hydrocephalus (OR 7.7, 95% CI 1.7-35.2), had higher Hunt-Hess grades (OR per point 2.3, 95% CI 1.2-4.5), or were discharged to home (OR 10.1, 95% CI 1.9-53.8), while higher Fisher scores were associated with less recovery (OR per point 0.4, 95% CI 0.2-0.7). Conclusions: A substantial proportion of patients with SAH who have disability at discharge have significant functional recovery at 6 months.