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Observational Study
. 2017 Dec;27(3):326-333.
doi: 10.1007/s12028-017-0425-4.

Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury

Anirudh Sreekrishnan  1 , Audrey C Leasure  2 , Fu-Dong Shi  3 , David Y Hwang  2 , Joseph L Schindler  2 , Nils H Petersen  2 , Emily J Gilmore  2 , Hooman Kamel  4 , Lauren H Sansing  2 , David M Greer  2 , Kevin N Sheth  2
Affiliations
Observational Study

Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury

Anirudh Sreekrishnan et al. Neurocrit Care. 2017 Dec.

Abstract

Background and purpose: As survival rates have increased for intracerebral hemorrhage (ICH) patients, there is limited information regarding recovery beyond 3-6 months. This study was conducted to examine recovery curves using the modified Rankin Scale (mRS) and Barthel Index (BI) up to 12 months post-injury.

Methods: We prospectively enrolled 173 patients admitted with ICH who were subsequently evaluated using the mRS and BI at discharge as well as 3, 6, and 12 months. Repeated measures nonparametric testing was conducted to assess functional trajectories across time.

Results: The mRS scores showed significant improvement between discharge (median 4) and 3 (median 4), 6 (median 4), and 12 months (median 3) (p values <0.001). However, the mRS scores did not differ between follow-up time-points (i.e., 3-6, 6-12 months). There was significant improvement in scores using the BI (p values <0.001), showing improvement between discharge (mean 43.0) and 3 (mean 73.0), 6 (mean 78.2), and 12 months (mean 83.4). Additionally, there were differences in the BI between 3 and 12 months (p = 0.013), as well as between 6 and 12 months (p = 0.025).

Conclusions: The BI may be a more sensitive measure of long-term recovery post-injury than the mRS, which shows minimal improvement for some survivors after 3 months. BI scores indicate survivors continually improve till 12 months post-injury. These results may have implications for the prognostication of ICH and design of clinical trial outcome measures.

Keywords: Cohort studies; Intracerebral hemorrhage; Outcome research; Prognosis.

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Figures

Figure 1
Figure 1
Proportion of patients observing a good outcome on the modified Rankin Scores (mRS), mRS < 3, and Barthel Index (BI), BI ≥ 85, from seven days to 12 months.
Figure 2
Figure 2
Improvement in distribution of mRS scores from seven days to 12 months.
Figure 3
Figure 3
Improvement in Barthel Index (BI) scores at seven days, three months, six months, and 12 months. * Significant at p < 0.05. ***Significant at p < 0.001.
See this image and copyright information in PMC

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