Article
Improvement of health-related quality of life after intracranial haemorrhage while neurosurgical early rehabilitation. Which predictors are relevant?
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Authors
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Thomas Kapapa
- Universitätsklinikum Ulm, Klinik für Neurochirurgie, Ulm
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Pia Linder
- Universitätsklinikum Ulm, Klinik für Neurochirurgie, Ulm
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Angela Pfaffenzeller
- Klinik am Schlossberg, Neurochirurgie, Heidenheim
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Dieter Woischneck
- Universitätsklinikum Ulm, Klinik für Neurochirurgie, Ulm
| Published: | March 21, 2014 |
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Outline
Text
Introduction: The capability of resources gains more and more impact while daily work in our health care system. There is the question of clinical development after intracranial haemorrhage while early rehabilitation. Which patients have the greatest benefit (when and how long)?
Material and methods: 115 patients after intracranial haemorrhage were transferred to the same rehabilitation facility after neurosurgical treatment. Data of early phase in primary hospital were compared with results of quality of life measurements in rehabilitation due to retrospective, descriptive-explorative measures and conaregression-scale calculations. The study was approved by a local ethics committee.
Results:
- 1.
- Potential of improvements and functional results decreased with increasing age. The age of 60 years represented a significant barrier in several scores.
- 2.
- Clinical parameters with predictive potency for an unfavourable functional result were: pre-existing anticoagulative treatment, higher coma graduation in primary hospital, sort and location of the lesion (spontaneous worse than traumatic haemorrhage, bilateral lesions were worst).
- 3.
- The duration of intubation represented in analogy to age a critical barrier. More than 400 hours of artificial ventilation represents a cut-off point for decrease of good functional results.
- 4.
- The potential of rehabilitation decreased after rehabilitation duration of more than 60 days. However, patients with initially bad clinical conditions presented a more improved status while increasing days of rehabilitation.
Conclusion: Age, origin of haemorrhage, coagulation, and initial coma grade, duration of artificial ventilation and duration of stay in primary hospital are relevant predictors for the outcome after spontaneous and traumatic intracranial haemorrhage. Patients with bad income conditions at the beginning of early rehabilitation have the greatest benefit of rehabilitation even after 60 days. Data enforce new thoughts about recent praxis of sponsors that want to end rehabilitation after 2–3 weeks without improvements.
