Hs. Jorgensen et al., What determines good recovery in patients with the most severe strokes? The Copenhagen stroke study, STROKE, 30(10), 1999, pp. 2008-2012
Background and Purpose-Even patients with the most severe strokes sometimes
experience a remarkably good recovery. We evaluated possible predictors of
a good outcome to search for new therapeutic strategies.
Methods-We included the 223 patients (19%)with the most severe strokes (Sca
ndinavian Stroke Scale score <15 points) from the 1197 unselected patients
in the Copenhagen Stroke Study. Of these, 139(62%) died in the hospital and
were excluded. The 26 survivors (31%) with a good functional outcome (Bart
hel Index greater than or equal to 50 points) were compared with the 58 sur
vivors(69%) with a poor functional outcome (Barthel Index <50 points). The
predictive value of the following factors was examined in a multivariate lo
gistic regression model: age; sex; a spouse;work; home care before stroke;
initial stroke severity; blood pressure, blood glucose, and body temperatur
e on admission; stroke subtype; neurological impairment I week after onset;
diabetes; hypertension; atrial fibrillation; ischemic heart disease; previ
ous stroke; and other disabling disease,
Results-Decreasing age (odds ratio [OR], 0.50 per 10-year decrease; 95% CI,
0.25 to 0.99; P=0.04), a spouse (OR, 3.1; 95% CI, 1.1 to 8.8; P=0.03), dec
reasing body temperature on admission (OR, 1.8 per 1 degrees C decrease; 95
% CI, 1.1 to 3.1; P=0.01), and neurological recovery after I week (OR, 3.2
per 10-point increase in Scandinavian Stroke Scale score; 95% CT, 1.1 to 7.
8; P=0.01) were all independent predictors of good functional outcome.
Conclusions-Patients with the most severe strokes who achieve a good functi
onal outcome are generally characterized by younger age, the presence of a
spouse at home, and early neurological recovery. Body temperature was a str
ong predictor of good functional outcome and the only potentially modifiabl
e factor. We suggest that a randomized controlled trial be undertaken to ev
aluate whether active reduction of body temperature can improve the general
ly poor prognosis of patients with the most severe strokes.