Treatment restrictions in patients with severe stroke are associated with an increased risk of death

Marjolein Geurts*, Floor A.S. de Kort, Paul L.M. de Kort, Julia H. van Tuijl, Ghislaine J.M.W. van Thiel, L. Jaap Kappelle, H. Bart van der Worp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)

Abstract

Introduction: Treatment restrictions in the first 2 days after intracerebral haemorrhage have been independently associated with an increased risk of early death. It is unknown whether these restrictions also affect mortality if these are installed several days after stroke onset. Patients and methods: Sixty patients with severe functional dependence at day 4 after ischaemic stroke or intracerebral haemorrhage were included in this prospective two-centre cohort study. The presence of treatment restrictions was assessed at the day of inclusion. Information about mortality, functional outcome (modified Rankin scale) score and quality of life (visual analogue scale) was recorded 6 months after stroke onset. Poor outcome was defined as modified Rankin scale >3. Satisfactory quality of life was defined as visual analogue scale ≥ 60. Results: At 6 months, 30 patients had died, 19 survivors had a poor functional outcome and 9 patients had a poor quality of life. Treatment restrictions were independently associated with mortality at 6 months (adjusted relative risk, 1.30; 95% confidence interval, 1.06–1.59; p = 0.01), but not with functional outcome. Discussion: Our findings were observed in 60 selected patients with severe stroke. Conclusion: The instalment of treatment restrictions by itself may increase the risk of death after stroke, even if the first 4 days have passed. In future stroke studies, this potential confounder should be taken into account. Quality of life was satisfactory in the majority of the survivors, despite considerable disability.

Original languageEnglish
Pages (from-to)244-249
Number of pages6
JournalEuropean Stroke Journal
Volume2
Issue number3
DOIs
Publication statusPublished - 1 Sept 2017

Keywords

  • ethics
  • mortality
  • Stroke
  • survival

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