Artikel
Disability paradox in spontaneous intracerebral haemorrhage – patients retrospectively consent to fibrinolytic surgery despite poor neurological outcome
Behinderungs-Paradoxon bei spontaner intrazerebraler Blutung – Patienten stimmen rückblickend einer fibrinolytischen Therapie zu, trotz schlechtem neurologischen Outcome
Suche in Medline nach
Autoren
Veröffentlicht: | 25. Mai 2022 |
---|
Gliederung
Text
Objective: Spontaneous intracerebral haemorrhage (ICH) might lead to neurological disability and mortality. Nonetheless, subjective interpretation of life circumstances might vary and depend on e.g. age or neurological function. Recent data from ischemic stroke patients show that there might be a paradox between an objectively rated neurological outcome and self-reported satisfaction with life. Our hypothesis was that surgically treated ICH patients would give their consent to the treatment retrospectively despite a relatively poor neurological outcome.
Methods: We identified all patients with spontaneous supratentorial ICH treated by minimally-invasive fibrinolytic therapy over a ten-year period (2010-2020) and conducted a retrospective analysis of demographic and clinical parameters. Subsequently, using standardized telephone interviews, we evaluated long-term functional outcome (good functional outcome was defined as mRS score of 0-3). We furthermore evaluated if the patients would have given their consent to the treatment retrospectively.
Results: Overall, 312 patients were identified, 80 were still alive when the study was conducted. The final analysis comprised 63 data sets (35 male and 28 female patients, mean age at diagnosis: 67 years). The median Hemphill score at surgery was 3 (0= 1.6%, 1=14.3%, 2= 30.2% 3=44.4%, 4=9.5%; 5=0%). The mean interval from haemorrhage to the interview was 71 ± 40 months. Good neurological outcome was achieved in 52% (33/63) of the patients. Regarding their initial ICH treatment, 89.7% (52/58) of the patients would have given their consent to surgery retrospectively. This sub-cohort comprised all 33 patients who achieved good functional outcome. A surprisingly high rate of 76% (19/25) also would have given their consent despite poor outcome. Patients with tracheostomy in hospital (p=0.006), speech disorders (p=0.026) and decline in concentration ability (p=0.026) would not have given informed consent for surgery.
Conclusion: Our data clearly shows a disability paradox. The study supports minimally invasive fibrinolytic treatment of ICH even in cases with an expected poor neurological outcome since subjective perception of deficits could be in contrast with the objectively measured neurological outcome. This is the first study assessing retrospective consent to minimally invasive surgical treatment in patients with ICH.