Article
Current data of health-related quality of life after subarachnoid hemorrhage
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Authors
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Thomas Kapapa
- Neurochirurgische Klinik, Universitätsklinikum Ulm, Germany
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Martin Thajadi
- Neurochirurgische Klinik, Universitätsklinikum Ulm, Germany
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Ralph König
- Neurochirurgische Klinik, Universitätsklinikum Ulm, Germany
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Christian Heinen
- Neurochirurgische Klinik, Universitätsklinikum Ulm, Germany
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Eckhard Rickels
- Klinik für Neurotraumatologie, Allgemeines Krankenhaus Celle, Germany
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Dieter Woischneck
- Neurochirurgische Klinik, Klinikum Landshut, , Germany
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Christian Rainer Wirtz
- Neurochirurgische Klinik, Universitätsklinikum Ulm, Germany
| Published: | September 16, 2010 |
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Outline
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Objective: Health-related quality of life is an accepted method to evaluate outcome. The application in surgery and especially in neurosurgery is rare although there are convincing results in other medical disciplines. It is an amendment to physical dominated scores like the Glasgow-Coma-Score. The recent results are presented after last series in the 90ies.
Methods: 530 patients and their members are standardized questioned about health-related quality of life by the Short-Form-36/12-Item-Survey, Sickness-Impact-Profile, Visual-Analogue-Scales and free questions. Topics like emotional and physical functioning and roles, pain, social functioning, psychological status and the state of health were evaluated. Summarizing scales are giving an overview. Values between 0 and 100 are created while 0 represents the worst and 100 the best equivalent to quality of life. The influence of clinical parameters are calculated by t-test and ANOVA (p≤0.05)
Results: 236 patients out of the period of 2000 to 2008 could be contacted successfully. Health-related quality of life after spontaneous subarachnoid hemorrhage is impaired. The values for the physical sumscala 45 (norm=50) as well as psychological sumscala 44 (norm=52) differ significantly from the norm. The physical role-functioning 58 (norm=84) and the emotional role-functioning 61 (norm=90) show worst impairments. Member rate quality of life less impaired: physical sumcala 43 (norm=49); psychological sumscala 48 (norm=52). Significant influencing clinical parameters are: 1. (p=0.001–0.01) sex, Hunt&Hess Score, Glasgow-Coma-Score, time between start of symptoms and admittance, duration of hospital stay, duration of artificial ventilation, WFNS-Score, hydrocephalus, Glasgow-Outcome-Score 2. (p=0.011–0.03) age, Bruessel-Coma-Score, neuropsychological abnormalities, tracheotomy, vasospasm, negative angiography 3. (p=0.031–0.05) intubation at admittance, cardio-vascular risks
Conclusions: Patients' rating of health status should be given the same attendance like his computertomographic pictures. A very good physical outcome could always be accompanied by impaired health-related quality of life. These results are not influenced by endovascular or surgical methods of treatment. Major influence on health-related quality of life comes from patients' factors as well as the duration of artificial ventilation. These are starting points for further improvements in treatment.
