Complications after acute stroke
Complications after acute stroke
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DOI：
10.1161/01.str.27.3.415
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发表时间：
1996-03-01
期刊：
影响因子：
8.3
通讯作者：
Warlow, CP
中科院分区：
文献类型：
--
作者：
Davenport, RJ;Dennis, MS;Warlow, CP
背景和目的 我们试图观察急性中风后住院患者发生并发症的类型、时间和频率。 方法 在一家医院中，我们前瞻性地确定了一组连续的患者，这些患者要么是急性中风后入院，要么是在住院期间发生中风的患者 (n=613)。我们检索了 607 例 (99%) 中风的病例记录，并由一名观察者使用预先定义的诊断标准审查记录并记录住院期间发生的并发症的类型、时间和频率。我们还通过比较两个观察者对记录样本的记录，衡量了病例记录审查中并发症识别的可靠性。结果 360 次中风后记录了并发症（59%）；最常见的并发症是跌倒（占所有中风的 22%）、皮肤破损（18%）和尿路（16%）或胸部（12%）感染。 32% 的中风因各种“其他”并发症而复杂化。癫痫发作和胸部感染发生得很早，而抑郁和肩膀疼痛则是后来的问题。并发症在老年患者中更为常见，他们在中风前更加残疾，并且中风更严重。我们证明了两位观察者对于大多数并发症的一致性达到了中等到良好。 结论 急性中风后的并发症很常见，这证实了中风康复需要积极且知识丰富的医疗投入。了解并发症的性质和发生时间，以及识别高危患者，可能对那些计划中风服务的人有用。我们的结果与之前报道的结果（尤其是皮肤破损）的差异可能是由于使用的方法不同，特别是患者选择和并发症的诊断标准。尽管并发症可能有助于衡量比较研究（例如治疗试验和审核）中的结果，但必须解决准确可靠地测量并发症的方法学困难。
Background and Purpose We sought to observe the type, timing, and frequency of complications occurring in hospitalized patients after an acute stroke.Methods In a single hospital, we prospectively identified a consecutive cohort of patients who were either admitted after an acute stroke or who suffered a stroke while already an inpatient (n=613). We retrieved the case notes for 607 (99%) of these strokes, and a single observer, using predefined diagnostic criteria, reviewed the notes and recorded the type, timing, and frequency of complications that occurred during the inpatient period. We also measured the reliability of complication identification from case note review by comparing two observers on a sample of records.Results Complications were recorded after 360 strokes (59%); the most common individual complications were falls (complicating 22% of all strokes), skin breaks (18%), and urinary tract (16%) or chest (12%) infections. Miscellaneous ''other'' complications complicated 32% of strokes. Seizures and chest infections occurred early, whereas depression and painful shoulder were later problems. Complications were more common in older patients, who were more disabled before their stroke and had suffered more severe strokes. We demonstrated moderate to good agreement between the two observers for most complications.Conclusions Complications after acute stroke are common, confirming that stroke rehabilitation requires active and knowledgeable medical input. Knowing the nature and timing of complications, together with the identification of high-risk patients, may be useful to those planning stroke services. The differences in our results and those previously reported, most notably for skin breaks, are probably due to the different methods used, in particular patient selection and diagnostic criteria for complications. Although complications may be useful as a measure of outcome in comparative studies (eg, therapeutic trials and audit), the methodological difficulties in accurately and reliably measuring them must be addressed.