Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors.

Abstract

To evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH). All patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985-1993, 1994-2002, and 2003-2011). Multivariable ordinal and logistic regression models were applied. Five hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87-3.23, p = 0.124 for 1994-2002; and OR 1.97, 95% CI, 1.08-3.60, p = 0.027 for 2003-2011 vs 1985-1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16-3.82, p = 0.014 for 1994-2002; and OR 2.73; 95% CI 1.54-4.84, p = 0.001 for 2003-2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24-0.99, p = 0.048 for 1994-2002; and OR 0.32, 95% CI 0.16-0.64, p = 0.001 for 2003-2011). The decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.