Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population

被引:657
作者
Lawrence, ES
Coshall, C
Dundas, R
Stewart, J
Rudd, AG
Howard, R
Wolfe, CDA [1 ]
机构
[1] Guys Kings & St Thomas Sch Med, Dept Publ Hlth Med, London SE1 3QD, England
[2] Guys & St Thomas Hosp Trust, Dept Care Elderly, London, England
[3] Guys & St Thomas Hosp Trust, Dept Neurol, London, England
关键词
racial differences; stroke assessment; stroke classification; stroke outcome;
D O I
10.1161/01.STR.32.6.1279
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose - The goals of the present study were to estimate the prevalence of acute impairments and disability in a multiethnic population of first-ever stroke and to identify differences in impairment and early disability between pathological and Bamford subtypes. Associations between impairments and death and disability at 3 months were identifed. Methods - Impairments that occur at the time of maximum neurological deficit were recorded, and disability according to the Barthel Ender (BI) was assessed 1 week and 3 months after stroke in patients in the South London Stroke Register. Results - Of 1259 registered patients, 6% had 1 or 2, 31.1% had 3 to 5, 50.6% had 6 to 10, and 10.6% had > 10 impairments. Common impairments were weakness (upper limb, 77.4%), urinary incontinence (48.2%), impaired consciousness (44.7%), dysphagia (44.7%), and impaired cognition (43.9%). Patients with total anterior circulation infarcts had the highest age-adjusted prevalence of weakness, dysphagia, urinary incontinence, cognitive impairment, and disability. Patients with subarachnoid hemorrhage had the highest rates of coma. Patients with lacunar stroke had the high prevalence of weakness but were least affected by disability, incontinence, and cognitive dysfunction. Blacks had higher age- and sex-adjusted rates of disability in ischemic stroke (BI < 20, odds ratio 2.76, 95% CI 1.47 to 5.21, P=0.002; BI < 15, odds ratio 1.8, 95% CI 1.45 to 2.81, P=0.01) but impairment rates similar to those of whites, On multivariable analysis, incontinence, coma, dysphagia, cognitive impairment, and gaze paresis were independently associated with severe disability (BI < 10) and death at 3 months. Conclusions - The extent of these findings indicates that an acute assessment of impairments and disability is necessary to determine the appropriate nursing and rehabilitation needs of patients with stroke.
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页码:1279 / 1284
页数:6
相关论文
共 44 条
[1]  
AHO K, 1980, B WORLD HEALTH ORGAN, V58, P113
[2]   PREDICTING THE OUTCOME OF ACUTE STROKE - A PROGNOSTIC SCORE [J].
ALLEN, CMC .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1984, 47 (05) :475-480
[3]  
[Anonymous], 1980, International classification of impairments, disabilities and handicaps
[4]   CLASSIFICATION AND NATURAL-HISTORY OF CLINICALLY IDENTIFIABLE SUBTYPES OF CEREBRAL INFARCTION [J].
BAMFORD, J ;
SANDERCOCK, P ;
DENNIS, M ;
BURN, J ;
WARLOW, C .
LANCET, 1991, 337 (8756) :1521-1526
[5]   THE NATURAL-HISTORY AND FUNCTIONAL CONSEQUENCES OF DYSPHAGIA AFTER HEMISPHERIC STROKE [J].
BARER, DH .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1989, 52 (02) :236-241
[6]   COMMUNITY HOSPITAL-BASED STROKE PROGRAMS - NORTH-CAROLINA, OREGON, AND NEW-YORK .2. DESCRIPTION OF STUDY POPULATION [J].
BECKER, C ;
HOWARD, G ;
MCLEROY, KR ;
YATSU, FM ;
TOOLE, JF ;
COULL, B ;
FEIBEL, J ;
WALKER, MD .
STROKE, 1986, 17 (02) :285-293
[7]  
Bougesslavsky J, 1988, STROKE, V19, P1083
[8]   Stroke and incontinence [J].
Brittain, KR ;
Peet, SM ;
Castleden, CM .
STROKE, 1998, 29 (02) :524-528
[9]   APHASIA IN ACUTE STROKE [J].
BRUST, JCM ;
SHAFER, SQ ;
RICHTER, RW ;
BRUUN, B .
STROKE, 1976, 7 (02) :167-174
[10]   RACE, SEX AND OCCLUSIVE CEREBROVASCULAR-DISEASE - A REVIEW [J].
CAPLAN, LR ;
GORELICK, PB ;
HIER, DB .
STROKE, 1986, 17 (04) :648-655