Predictor Of Poor Functional Outcome Research Articles

Detection of copeptin in peripheral blood of patients with aneurysmal subarachnoid hemorrhage

IntroductionCopeptin has been proposed as a prognostic marker in acute illness. This study investigated the ability of copeptin to predict the disease outcome and cerebrovasospasm in the patients with aneurysmal subarachnoid hemorrhage.MethodsIn this retrospective study, 303 consecutive patients were included. Upon admission, plasma copeptin levels were measured by enzyme-linked immunosorbent assay. The end points were mortality after 1 year, in-hospital mortality, cerebrovasospasm and poor functional outcome (Glasgow Outcome Scale score of 1-3) after 1 year.ResultsUpon admission, plasma copeptin level in patients was statistically significantly higher than that in healthy controls. A multivariate analysis showed that plasma copeptin level was an independent predictor of poor functional outcome and mortality after 1 year, in-hospital mortality and cerebrovasospasm. A receiver operating characteristic curve showed that plasma copeptin level on admission predicted poor functional outcome and mortality after 1 year, in-hospital mortality and cerebrovasospasm of patients statistically significantly. The area under curve of the copeptin concentration was similar to those of World Federation of Neurological Surgeons (WFNS) score and modified Fisher score for the prediction of poor functional outcome and mortality after 1 year, and in-hospital mortality, but not for the prediction of cerebrovasospasm. In a combined logistic-regression model, copeptin improved the area under curve of WFNS score and modified Fisher score for the prediction of poor functional outcome after 1 year, but not for the prediction of mortality after 1 year, in-hospital mortality, and cerebrovasospasm.ConclusionsCopeptin level is a useful, complementary tool to predict functional outcome and mortality after aneurysmal subarachnoid hemorrhage.

Frontal Cortical Networks, Impaired Cognitive Control and Disorganization in Schizophrenia

Event Abstract Back to Event Frontal Cortical Networks, Impaired Cognitive Control and Disorganization in Schizophrenia Cameron Carter1* 1 University of California, Davis, United States Schizophrenia is a common mental disorder affecting both genders and at least 1% of the population. It has its onset in late adolescence and leads to major personal and family disruption and for many individuals lifelong impairment in social and social functioning. Impaired cognition in schizophrenia is present at the onset of the illness, persists across the lifespan and is the strongest predictor of poor functional outcome in the illness. Our presently available treatments have little if any impact on this aspect of the illness making developing effective treatments for impaired cognition in schizophrenia a critical challenge for biomedicine in the 21st century. People with schizophrenia are impaired across a range of cognitive functions including attention, working and episodic memory and language comprehension and production. One parsimonious theory that draws upon an influential model from cognitive neuroscience is that patents have impairments of cognitive control, in the service of which the prefrontal cortex supports task appropriate performance by recruiting task appropriate networks across the brain. fMRI studies support the presence of PFC dysfunction in schizophrenia that is associated with impaired recruitment of task appropriate networks and these deficits are independent of medication status or stage of the illness. They also predict the level of clinical disorganization in patients as well as their level of functioning. Post mortem studies in schizophrenia suggest altered connectivity in local circuits in the prefrontal cortex that participate in the establishment of high frequency (gamma band) oscillations. Furthermore cognitive EEG studies in schizophrenia show reduced cognitive control related gamma oscillations across frontal electrodes in schizophrenia. These suggest a model of schizophrenia in which altered development of local networks impair the ability to endogenously generate gamma synchrony in the PFC, and this leads to altered recruitment of task appropriate networks, cognitive impairment, behavioral disorganization and impaired functioning. Recent refinements in the cognitive control model of cognitive impairment in schizophrenia will be discussed in addition to strategies for developing effective treatments for impaired cognition in the illness.

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

IntroductionThe impact of anemia on functional outcome and mortality in patients suffering from non-traumatic intracerebral hemorrhage (ICH) has not been investigated. Here, we assessed the relationship between hemoglobin (HB) levels and clinical outcome after ICH.MethodsOne hundred and ninety six patients suffering from supratentorial, non-traumatic ICH were extracted from our local stroke database (June 2004 to June 2006). Clinical and radiologic computed tomography data, HB levels on admission, mean HB values and nadir during hospital stay were recorded. Outcome was assessed at discharge and 3 months using the modified Rankin score (mRS).ResultsForty six (23.5%) patients achieved a favorable functional outcome (mRS ≤ 3) and 150 (76.5%) had poor outcome (mRS 4 - 6) at discharge. Patients with poor functional outcome had a lower mean HB (12.3 versus 13.7 g/dl, P < 0.001) and nadir HB (11.5 versus 13.0 g/dl, P < 0.001). Ten patients (5.1%) received red blood cell (RBC) transfusions. In a multivariate logistic regression model, the mean HB was an independent predictor for poor functional outcome at three months (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P = 0.007), along with National Institute of Health Stroke Scale (NIHSS) at admission (OR 1.17, 95% CI 1.11 - 1.24, P < 0.001), and age (OR 1.08, 95% CI 1.04 - 1.12, P < 0.001).ConclusionsWe report an association between low HB and poor outcome in patients with non-traumatic, supratentorial ICH. While a causal relationship could not be proven, previous experimental studies and studies in brain injured patients provide evidence for detrimental effects of anemia on brain metabolism. However, the potential risk of anemia must be balanced against the risk of harm from red blood cell infusion.

Gender Differences in the Functional Recovery after Acute Stroke

Background and PurposePurposezzInterest in gender differences in the effects of acute stroke is growing worldwide. However, gender differences in functional recovery after acute stroke in the Korean population have yet to be evaluated. The aim of this investigation was to compare long-term functional outcomes between male and female after acute stroke.MethodsPatients with acute stroke were enrolled prospectively between January 2005 and January 2009. Baseline characteristics, risk factors, stroke subtypes, time delay from onset to arrival at a hospital, active treatment, and stroke severity were compared between male and female. Differences in mortality and disability at discharge, and at 3 months and 1 year after stroke onset were also investigated. Functional disabilities were categorized into two groups: good outcome (score on modified Rankin scale ≤2) and poor outcome (score on modified Rankin scale >2).ResultsAmong 1,055 patients with acute stroke, 575 were male (aged 64.83±11.98 years, mean±SD) and 480 were female (aged 70.09±13.02 years). There were no gender differences in mortality at 3 months and 1 year after stroke. The frequency of poor outcomes was higher in female patients than in male patients at discharge (39.8% versus 30.9%, respectively; p=0.003), the 3 months follow-up (32.3% versus 20.8%, respectively; p<0.001), and the 1 year follow-up (31.1% versus 18.7%, respectively; p=0.001). After adjusting for multiple confounding factors including age and stroke severity, the female gender persisted as a predictor of poor functional outcome at 3 months and 1 year after stroke.ConclusionsFemale patients have greater difficulty than male patients in recovering from a disabled state after acute stroke. Future studies should investigate the causes of this gender difference.

Outcomes of Total Knee Arthroplasty in English-Versus Non–English-Speaking Patients

To compare outcomes of total knee arthroplasty (TKA) in English- versus non-English-speaking patients. 193 women and 85 men (mean age, 72 years) underwent 117 left and 161 right primary TKAs. 237 and 41 patients were English and non-English speaking, respectively. Interpretation was provided. Pre- and post-operative functional outcomes were measured using the International Knee Society (IKS) score. Most non-English-speaking patients were female (38 vs 3 of 41, p<0.001). The mean body mass index of non-English-speaking patients was significantly higher (34 vs 31 kg/m[2], p=0.003). 14 foreign languages were spoken among the 41 non-English-speaking patients, of which Greek and Italian were the most common. Non-English-speaking patients had significantly worse IKS scores both preoperatively and at the 12-month follow-up. The proportions of poor postoperative IKS scores were significantly higher in non-English-speaking patients (58% vs 27%, p<0.001), in whom pain was also significantly worse (p=0.017). In a multiple logistic regression analysis, being non-English speaking was the only predictor of poor functional outcome at the 12-month follow-up (odds ratio=2.77, confidence interval=1.25-6.14, p=0.012). The non-English-speaking background of a patient is a predictor of less favourable functional outcome after TKA.

Thrombolyse intraveineuse par rt-PA des accidents vasculaires cérébraux ischémiques : l’expérience de l’unité neurovasculaire de Nice

Introduction Intravenous thrombolysis with rt-Pa in stroke has been approved in France since 2002. We report an evaluation of our practice. We have tried to identify predictive factors of dependence and death, and to compare our results with the data of the literature. Patients and method All patients treated with intravenous rt-PA within the first 270 min after the stroke onset were included. Univariate, then multivariate analyses were performed to determine the variables influencing the functional outcome at 3 months follow-up, according to a dichotomy established from the modified Rankin scale. Results One hundred and forty-two patients were included in this study (mean initial National Institute of Health Stroke Scale [NIHSS]: 15). Fifty percent had a Rankin score higher than 2 at 3 months follow-up. NIHSS above 12, glycemia of at least 120 mg/l, and systolic blood pressure above 160 mmHg at admission were identified as independent predictive factors of poor functional outcome. Less than 4 points decrease of NIHSS proved to be a simple and early predictor of poor functional outcome at 3 months follow-up. Conclusions In terms of safety and efficacy the data issuing from the daily activity of our stroke unit are comparable with those of clinical trials.

破裂脳動脈瘤の治療成績―札幌圏における北大グループの現況（２００３〜２００７）―

Recent multi-center studies in Western countries have clarified various aspects of aneurysmal subarachnoid hemorrhage (SAH) as part of evidence-based medicine (EBM). In Japan, however, much less evidence on aneurysmal SAH has been established. In this study, therefore, we prospectively enrolled 836 patients with aneurysmal SAH admitted to Hokkaido University Hospital and its affiliate hospitals in Sapporo area between 2003 and 2007, and analyzed their epidemiology, therapy and functional outcome. Of totally 836 patients, 130 (15.6%) and 214 (25.6%) were categorized into WFNS Grade 4 and 5, respectively. Totally, 689 patients (82.4%) underwent some interventions for ruptured aneurysms, including surgical clipping in 548 patients and endovascular coiling in 121. Of these, favorable functional outcome at 1 month after the onset was obtained in 461 patients (66.9%). Multivariate logistic regression analysis revealed that age, neurological severity, intracerebral hematoma, symptomatic vasospasm, and normal pressure hydrocephalus were independent predictors for poor functional outcome. The present results suggest the importance of prospective multi-center, cohort or randomized study on aneurysmal SAH in Japan.

Traumatic Thoracic and Lumbar Spinal Fractures: Operative or Nonoperative Treatment

A center parallel cohort study with blinded inclusion based on clinical equipoise. To compare outcomes of nonoperative and operative treatment strategies in terms of quality of life and neurologic and functional status. Despite a considerable body of literature, sound evidence regarding the optimal treatment for traumatic thoracic and lumbar spine fractures is lacking. Medical records of patients hospitalized for traumatic spinal fractures between 1991 and 2002 were identified in 2 trauma centers in the same country with established and different treatment strategies. Eligibility was retrospectively assessed for each case by a panel of orthopaedic surgeons who were representative of the 2 medical centers, and who were blinded to the treatment actually administered. Patients were included in the study when there was disagreement on the suggested treatment method. Thus, 2 comparable groups were identified undergoing nonoperative or operative treatment. Outcome assessment and comparison across groups focused on quality of life, residual pain, neurologic recovery, and employment in the middle-long-term follow-up. Discordance in regards to choice of treatment was identified in 190 (95 treated nonoperative, 95 operative) of 636 potentially eligible patients. Patients were comparable regarding baseline characteristics, except for a somewhat higher proportion of males and neurologic impairment in the operative group. Seventeen percent of the nonoperative and 21% of the operative group developed complications and 3 patients displayed neurologic deterioration for which a treatment change was considered necessary. Follow-up was complete in 79%; mean follow-up time was 6.2 years with a minimum of 2 years. Pain scores, disability indexes, and general health outcome were comparable at follow-up. Compared with matched population norms, outcomes were poorer regardless of treatment method. Neurologic recovery was better in the operative group, but this difference did not reach statistical significance. Multivariate regression analyses revealed that female gender and neurologic impairment were independent predictors of poor functional outcome. Eighty-eight and 83% of the nonoperatively and operatively treated patients were employed at some point after a rehabilitation period. Overall outcome of nonoperative and operative treatment in middle-long-term follow up is comparable, although there seems to be a difference in neurologic recovery patterns. Studies on the cost-effectiveness of treatment options and the patterns of recovery within 2 years after injury would assist in guideline development and stimulate interest for future research.

Predictive factors of outcome and stroke recurrence in patients with unilateral atherosclerosis-related internal carotid artery occlusion

Clinical outcome of internal carotid artery (ICA) occlusion is highly variable and the reason is uncertain. To study the predictive factors of clinical outcome and stroke recurrence in patients with ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion. Prospective study in neurology department of a single hospital. We prospectively studied 66 patients who suffered from first-ever ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion over a period of two years. The end point was death or stroke recurrence. Chi-square or Fisher's exact test was used to analyze predictors of early functional outcome. Multivariate analysis was used to analyze predictors of death or stroke recurrence within two years. Higher age (>or=70 years) predicted a worse functional outcome (P=0.049). Total anterior circulation syndrome (TACS) was associated with a poor functional outcome (P<0.001), but lacunar syndrome had a better outcome (P=0.001). Stroke in evolution predicted a poor outcome (P=0.001), while those with symptom improvement had a better outcome (P=0.016). Pneumonia predicted a poor outcome (P=0.021). Five patients expired and 22 patients suffered from recurrent stroke in the following 24 months. Previous transient ischemic attack (TIA) and anemia were associated with a higher risk of death or recurrent stroke within two years (P=0.036, P=0.012). High age, TACS, stroke in evolution and pneumonia were predictors for poor functional outcome. Previous TIA and anemia were predictors for death and recurrent stroke within two years.

Difference in outcome of shoulder surgery between workers’ compensation and nonworkers’ compensation populations

The purpose of this study was to review the association between compensation status and surgical outcome especially of the shoulder. Given the high prevalence of shoulder injuries in the workplace and the large proportion of workers compensation (WC) claims involving such injuries, it is worth examining the correlation between WC status and surgical outcome of the shoulder. All studies published in journals (MEDLINE and PubMed) from 1980 through 2007 on surgical interventions performed on the shoulder in which workers compensation status was documented and the postoperative functional outcome was compared according to that status were pooled for meta-analysis. This systematic review shows that compensation status of an individual receiving shoulder surgery is a consistent positive predictor of poor functional outcome. The majority of questions posed in the most commonly adopted shoulder-specific functional outcome measurement tools were subjective in nature and may account for part of the phenomenon.

Outcome after Complicated Minor Head Injury

Functional outcome in patients with minor head injury with neurocranial traumatic findings on CT is largely unknown. We hypothesized that certain CT findings may be predictive of poor functional outcome. All patients from the CT in Head Injury Patients (CHIP) study with neurocranial traumatic CT findings were included. The CHIP study is a prospective, multicenter study of consecutive patients, > or =16 years of age, presenting within 24 hours of blunt head injury, with a Glasgow Coma Scale (GCS) score of 13-14 or a GCS score of 15 and a risk factor. Primary outcome was functional outcome according to the Glasgow Outcome Scale (GOS). Other outcome measures were the modified Rankin Scale (mRS), the Barthel Index (BI), and number and severity of postconcussive symptoms. The association between CT findings and outcome was assessed by using univariable and multivariable regression analysis. GOS was assessed in 237/312 patients (76%) at an average of 15 months after injury. There was full recovery in 150 patients (63%), moderate disability in 70 (30%), severe disability in 7 (3.0%), and death in 10 (4.2%). Outcome according to the mRS and BI was also favorable in most patients, but 82% of patients had postconcussive symptoms. Evidence of parenchymal damage was the only independent predictor of poor functional outcome (odds ratio = 1.89, P = .022). Patients with neurocranial complications after minor head injury generally make a good functional recovery, but postconcussive symptoms may persist. Evidence of parenchymal damage on CT was predictive of poor functional outcome.

Therapeutische Interventionen bei unilateralem Neglekt und ihre Wirkung auf Alltagstätigkeiten - Ein Review

INTRODUCTION: Unilateral neglect is a well recognized predictor of poor functional outcome in stroke rehabilitation. The syndrome has important implications for occupational therapy due to its manifestations regarding impaired activities of daily living. This review presents the current therapeutic interventions for unilateral neglect and investigates if there are benefits for neglect subjects in reducing existing limitations in activities of daily living. METHOD: A comprehensive literature review was conducted on studies until January 2007 in the databases of AMED, CINAHL, MEDLINE, PsycINFO, PEDro, OTseeker, Global Health, and Cochrane Library. Study designs, population, intervention itself and the effect of the intervention on daily occupations were analysed. RESULTS: 3 RCT and 35 other studies (case and crossover studies) were identified: 8 studies aimed at activating the right hemisphere, 5 of which focused on scanning training, computer assistive strategies and prism adaptation, and several studies investigated six other methods of intervention. Some therapeutic strategies showed reduced neglect symptoms but only with short lasting benefits. A positive effect on activities of daily living was indicated in 7 studies. No recommended intervention guideline has been developed to date. CONCLUSIONS: Present studies with varying approaches to unilateral neglect show little evidence for the interventions’ positive effects on everyday activities. They have methodological flaws and small samples with tendency to focus on cognitive function rather than successful achievement of occupation.

Long-Term Management Strategies to Achieve Optimal Function in Patients With Bipolar Disorder

Functional impairment is a problem for people with bipolar disorder. Predictors of poor functional outcome are psychiatric and medical comorbidity, interepisode subsyndromal symptoms, psychosis during a manic or mixed episode, and low premorbid functioning. Cognitive dysfunction may also be a contributory factor in functional impairment. Several psychosocial interventions designed for people with bipolar disorder have demonstrated success in improving syndromal outcomes, but the effects of psychosocial interventions on functioning and cognition have not been examined. Among pharmacologic interventions available for long-term treatment of bipolar disorder, there is a strong clinical trend away from monotherapy and toward combination therapy. Lithium, lamotrigine, olanzapine, and aripiprazole have all shown substantial improvements in relapse rates compared with placebo. Although some of these medications show superior results compared with the others in preventing the recurrence of either depressive or manic episodes, only anecdotal evidence exists regarding their effect on cognition. Combination therapy with antipsychotics or antidepressants has also been shown to produce better syndromal outcomes in people with bipolar disorder, but inadequate evidence is available on cognitive outcomes. Substantial information is needed regarding the prevalence and causes of cognitive dysfunction in bipolar disorder, the effects of existing treatments on cognition, and long-term treatments to improve cognition and functioning.

Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal

The purpose of this study was to identify those factors that influence the outcome after conservative treatment of undisplaced fractures of the fifth metatarsal. This was done with univariate analyses and, for the first time, with regression analyses of day-to-day clinical practice. Thirty-eight patients were treated with plaster and periods of no weight bearing (NWB). Their mean age was 48 years. They were evaluated using the Olerud ankle score, with analogue scales for pain and comfort, and with questions about cosmesis and wearing of shoes. Six patients sustained a Jones fracture and 32 a tuberosity avulsion fracture. The mean period of NWB was 17 days and of casting was 38 days. Three Jones fractures and all the avulsion fractures were healed at the end of treatment. After a mean of 490 days, the global ankle score was 82/100. Ten patients reported problems with shoes and nine reported cosmetic problems. The linear analogue scale for pain was 2.11/10 and for comfort 8.42/10. Gender, age, and fracture type did not affect outcome. The most significant predictor of poor functional outcome was longer NWB, which was strongly associated with worse global outcome, discomfort, and reported stiffness. NWB should be kept to a minimum for acute avulsions of the tuberosity of the fifth metatarsal.

Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care?

The decision to maintain intensive treatment in cardiac surgical patients with poor initial outcome is mostly based on individual experience. The risk scoring systems used in cardiac surgery have no prognostic value for individuals. This study aims to assess (a) factors possibly related to poor survival and functional outcomes in cardiac surgery patients requiring prolonged (> or = 5 days) intensive care unit (ICU) treatment, (b) conditions in which treatment withdrawal might be justified, and (c) the patient's perception of the benefits and drawbacks of long intensive treatments. The computerized data prospectively recorded for every patient in the intensive care unit over a 3-year period were reviewed and analyzed (n=1859). Survival and quality of life (QOL) outcomes were determined in all patients having required > or =5 consecutive days of intensive treatment (n=194/10.4%). Long-term survivors were interviewed at yearly intervals in a standardized manner and quality of life was assessed using the dependency score of Karnofsky. No interventions or treatments were given, withhold, or withdrawn as part of this study. In-hospital, 1-, and 3-year cumulative survival rates reached 91.3%, 85.6%, and 75.1%, respectively. Quality of life assessed 1 year postoperatively by the score of Karnofsky was good in 119/165 patients, fair in 32 and poor in 14. Multivariate logistic regression analysis of 19 potential predictors of poor outcome identified dialysis as the sole factor significantly (p=0.027) - albeit moderately - reducing long-term survival, and sustained neurological deficit as an inconstant predictor of poor functional outcome (p=0.028). One year postoperatively 0.63% of patients still reminded of severe suffering in the intensive station and 20% of discomfort. Only 7.7% of patients would definitely refuse redo surgery. This study of cardiac surgical patients requiring > or =5 days of intensive treatment did not identify factors unequivocally justifying early treatment limitation in individuals. It found that 1-year mortality and disability rates can be maintained at a low level in this subset of patients, and that severe suffering in the ICU is infrequent.

Therapeutic Effects of Caloric Stimulation and Optokinetic Stimulation on Hemispatial Neglect

Hemispatial neglect refers to a cognitive disorder in which patients with unilateral brain injury cannot recognize or respond to stimuli located in the contralesional hemispace. Hemispatial neglect in stroke patients is an important predictor for poor functional outcome. Therefore, there is a need for effective treatment for this condition. A number of interventions for hemispatial neglect have been proposed, although an approach resulting in persistent improvement is not available. Of these interventions, our review is focused on caloric stimulation and optokinetic stimulation. These lateralized or direction-specific stimulations of peripheral sensory systems can temporarily improve hemispatial neglect. According to recent functional MRI and PET studies, this improvement might result from the partial (re)activation of a distributed, multisensory vestibular network in the lesioned hemisphere, which is a part of a system that codes ego-centered space. However, much remain unknown regarding exact signal timing and directional selectivity of the network.

Long-term outcome after hemicraniectomy for space occupying right hemispheric MCA infarction

Objective To examine the long-term prognosis in patients with ‘malignant’ supratentorial ischemia of the right hemisphere treated with hemicraniectomy, especially in respect to depression, with a focus on age as a possible predictor of outcome. Methods We performed a prospective, long-term, follow-up examination in 23 survivors of 32 patients (mortality 28.1%) treated with hemicraniectomy for malignant middle cerebral artery (MCA) infarction of the right hemisphere, who were identified in our data bank since 1993. Long-term was defined as at least 20 months after craniectomy. Outcome data consisted of the items functionality, depression and quality of life. Tests applied included the Barthel Index (BI), the modified Rankin Scale (mRS), Beck Depression Inventory (BDI) and stroke-specific quality of life (QoL) scale. Results Of the 23 patients 15 (65.2%) had a BI ≥ 60, 11 (47.8%) a mRS < 4 and 9 (39.1%) a SS-QOL ≥ 60%, each representing a favourable outcome. In retrospect, 14 (60.9%) patients approved the surgery. Depression, i.e. a BDI > 9, was diagnosed in 13 (56.5%) patients and 5 (38.5%) of them were treated with antidepressants. In a multiple linear regression analysis age at craniectomy was a predictor of a low BI (beta = −0.863; p = 0.031), but not of the other outcome parameters. Conclusions Depression is a common and rarely treated long-term complication after ‘malignant’ right hemispheric ischemia. While high age is a strong predictor of poor functional outcome, it has no impact on depression and retrospective approval of craniectomy.

Results of spinal meningioma surgery in patients with severe preoperative neurological deficits

Spinal meningiomas are usually benign, slow-growing tumours and are commonly associated with good patient outcome following surgery. However, the existence of a severe preoperative neurological deficit has been considered to be a possible predictor of poor functional outcome after surgery. We retrospectively reviewed data from 33 patients with 35 spinal meningiomas treated in our institution over the past 17 years and exhibiting severe preoperative deficits before surgery. Among them, 20 suffered from paraparesis and 13 were paraplegic. The mean follow-up duration was 70.7 months (range 12-183 months). By the 1-year follow-up, all patients had improved in comparison with their preoperative neurological status, and 60% of them had totally recovered. It can be concluded from this study, that, in the vast majority of cases, patients harbouring spinal meningioma with severe preoperative deficits can expect a good outcome.

Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation

Objectives: To examine a very large dataset to provide a robust answer to the question of whether visible infarction on computed tomography was (a) an independent predictor of functional outcome...

Early predictors of poor functional outcome in systemic-onset juvenile rheumatoid arthritis: a multicenter cohort study.

To examine the ability of a previously described set of criteria to predict poor functional outcome in a large, multicenter cohort of children with systemic-onset juvenile rheumatoid arthritis (JRA). All children who were diagnosed with systemic-onset JRA since 1980 at the Hospital for Sick Children (Toronto), since 1983 at the Isaac Walton Killam Hospital for Children (Halifax), and since 1981 at the Children's Hospital of Eastern Ontario (Ottawa) were evaluated. Patients were included in the study if they had been evaluated clinically within 6 months of diagnosis and had been followed up for at least 2 years. Patients were divided into 4 cohorts according to their length of followup: 2-4 years, 4-7 years, 7-10 years, and >10 years. Using previously described criteria for destructive arthritis in children with systemic-onset JRA, the patients were classified as either high risk or low risk for poor functional outcome based on the data from their 6-month visit. High-risk patients had active systemic disease (persistent fever or corticosteroid requirement for control of systemic disease) and a platelet count > or =600 x 10(9)/liter. Poor outcome was defined as moderate or severe disability (defined as a score of > or =0.75 on the Childhood Health Assessment Questionnaire) or disease-associated death. Among 122 eligible patients with systemic-onset JRA, we were able to contact 111 (91%) for outcome data. The mean followup period was 7.7 years (SD 3.7). The mean age at outcome assessment was 13.5 years (SD 5.3). There were 51 boys and 60 girls. Twenty-four patients (22%) had moderate-to-severe disability and 2 patients died; these 26 patients were considered to have had a poor outcome. We could determine risk classification for 104 patients. Twenty-four patients (23%) met the criteria for high risk at the 6-month visit. Overall, the risk of a poor functional outcome was significantly higher in the high-risk group (relative risk 3.3, 95% confidence interval [95% CI] 1.73-6.43, P = 0.0004). This risk was most marked in the cohort with > 10 years of followup (relative risk 4.3, 95% CI 1.82-10.29, P = 0.006). The presence of active systemic disease at 6 months, as characterized by fever or the need for corticosteroids, and thrombocytosis strongly predicted the development of a poor functional outcome in these patients. This was especially apparent with longterm followup. Our study validates the previously developed prognostic criteria for systemic-onset JRA.