Abstract

Introduction: Acute stroke (AS) is the third most common cause of disability in adults. Identifying predictive factors of its functional prognosis is necessary to accurate prediction of patient outcomes.

Aim of the Study: The aim of our study was to identify significant predictors of poor functional outcome in patients presenting with AS to the emergency department (ED).

Methods: Prospective monocentric study conducted over six years and six months. Inclusion of all adults patients admitted to the ED with symptoms of AS. Clinical, anamnestic, demographic and radiological characteristics were recorded. Use of the National Institutes of Health Stroke Scale (NIHSS) and Rankin modified score (mRS). Functional prognosis was evaluated at 3 months after the acute episode with the mRS. Severe disability was considered if mRS = 4 or 5. We proceeded to a comparative analysis between two groups: patients with severe disability (mRS = 4 or 5) versus patients with mild to moderate disability (mRS ≤ 3).

Results: Inclusion of 232 patients. Mean age = 67 ±13 years. Sex ratio = 1.41. Two hundred and two patients (87%) were totally independent before the acute episode (mRS ≤ 2). After 3 months, 18% of patients were severely impaired. Independent risk factors associated with this severe disability were: age ≥ 70 years (adjusted OR = 1.49, 95%CI: 1.11 - 2.19), NIHSS score ≥ 11 (adjusted OR = 1.86, 95%CI: 1.23 - 2.81) and GCS ≤ 11 (adjusted OR = 1.57, 95%CI: 1.13 - 2.56).

Conclusion: Early identification, from the ED, of predictive factors of functional outcome of AS may improve patients’ later functional independence level.

Keywords: Acute Stroke; Prognosis; Emergency Department; Functional Outcome; Disability

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