Abstract
Comparison studies on recovery outcomes in ischemic (IS) and hemorrhagic strokes (HS) have yielded mixed results. In this retrospective observational study of consecutive IS and HS patients, we aimed at evaluating functional outcomes at discharge from an intensive rehabilitation hospital, comparing IS vs. HS, analyzing possible predictors. Modified Rankin Scale (mRS) at discharge was the main outcome. Out of the 229 patients included (mean age 72.9 ± 13.9 years, 48% males), 81 had HS (35%). Compared with IS (n = 148), HS patients were significantly younger (75 ± 12.5 vs. 68.8 ± 15.4 years, p = 0.002), required longer hospitalizations both in acute (23.9 ± 36.7 vs. 35.2 ± 29.9 days, p = 0.019) and rehabilitation hospitals (41.5 ± 31.8 vs. 77.2 ± 51.6 days, p = 0.001), and had more severe initial clinical deficit (mean number of neurological impairments: 2.0 ± 1.1 vs. 2.6 ± 1.4, p = 0.001) and mRS scores at admission (p = 0.046). At discharge, functional status change, expressed as mRS, was not significantly different between IS and HS (F = 0.01, p = 0.902), nor was the discharge destination (p = 0.428). Age and clinical severity were predictors of functional outcome in both stroke types. On admission in an intensive rehabilitation hospital, HS patients presented a worse functional and clinical status compared to IS. Despite this initial gap, the two stroke types showed an overlapped trajectory of functional recovery, with age and initial stroke severity as the main prognostic factors.
Highlights
Stroke is one of the world’s leading causes of death and disability
The results of this study showed that hemorrhagic strokes presented a worse functional and clinical status compared to ischemic strokes at admittance in an intensive rehabilitation unit
The two types of stroke showed an overlapped trajectory of functional recovery, considering the effect of influencing factors such as age, sex, duration of stay in the rehabilitation hospital, and functional and clinical burden on admission
Summary
Stroke is one of the world’s leading causes of death and disability. Ischemic stroke is nowadays considered a time-dependent disease due to the availability of acute treatments and represents 87% of all strokes [1]. Hemorrhagic strokes include intracerebral hemorrhage, representing 10% of all strokes, and aneurysmal subarachnoid hemorrhage, which represents 3% of all strokes [1]. In 2017, a total of 2.7 million individuals died of ischemic stroke, 3 million of intracerebral hemorrhage, and 0.4 million of aneurysmal subarachnoid hemorrhage [1]. The general prognosis of ischemic stroke is considered better than that of hemorrhagic stroke, in which death occurs especially in the acute and subacute phases [2,3]. Neurologic rehabilitation has the potential to affect functional outcomes in stroke patients by means of many different mechanisms [4]. Post-stroke recovery has been widely studied mainly in ischemic stroke, but as pathophysiology between ischemic and hemorrhagic forms is different, it could be hypothesized that mechanisms of recovery and outcomes are dissimilar [5]
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