Abstract
We established spatial neglect prevalence, disease profile and amount of therapy that inpatient stroke survivors received, and outcomes at discharge using Sentinel Stroke National Audit Programme (SSNAP) data. We used data from 88,664 National Health Service (NHS) admissions in England, Wales and Northern Ireland (July 2013–July 2015), for stroke survivors still in hospital after 3 days with a completed baseline neglect National Institute for Health Stroke Scale (NIHSS) score. Thirty percent had neglect (NIHSS item 11 ≥ 1) and they were slightly older (78 years) than those without neglect (75 years). Neglect was observed more commonly in women (33 vs. 27%) and in individuals with a premorbid dependency (37 vs. 28%). Survivors of mild stroke were far less likely to present with neglect than those with severe stroke (4% vs. 84%). Those with neglect had a greatly increased length of stay (27 vs. 10 days). They received a comparable amount of average daily occupational and physiotherapy during their longer inpatient stay but on discharge a greater percentage of individuals with neglect were dependent on the modified Rankin scale (76 vs. 57%). Spatial neglect is common and associated with worse clinical outcomes. These results add to our understanding of neglect to inform clinical guidelines, service provision and priorities for future research.
Highlights
Spatial neglect is a distressing consequence of stroke [1] associated with a worse outcome [2]
It is not surprising that neglect early after stroke [8,9], as well as enduring neglect [10,11,12], is a prognostic indicator for reduced functional independence following stroke [13]. This is further impacted by the association of neglect with more severe sensory impairment [14] which is in itself a prognostic indicator of poorer recovery after stroke [15]
During the data extraction period (July 2013 to July 2015) 149,560 stroke patients were admitted to hospital and entered into the Sentinel Stroke National Audit Programme (SSNAP) clinical audit. 41,706 were excluded as they had a length of stay (LoS)
Summary
Spatial neglect is a distressing consequence of stroke [1] associated with a worse outcome [2]. It is a heterogeneous syndrome rather than a single impairment [3]. It is not surprising that neglect early after stroke [8,9], as well as enduring neglect [10,11,12], is a prognostic indicator for reduced functional independence following stroke [13] This is further impacted by the association of neglect with more severe sensory impairment [14] which is in itself a prognostic indicator of poorer recovery after stroke [15]
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