Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors

Abstract

<h3>Objective</h3> To evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH). <h3>Methods</h3> All patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985–1993, 1994–2002, and 2003–2011). Multivariable ordinal and logistic regression models were applied. <h3>Results</h3> Five hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87–3.23, <i>p</i> = 0.124 for 1994–2002; and OR 1.97, 95% CI, 1.08–3.60, <i>p</i> = 0.027 for 2003–2011 vs 1985–1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16–3.82, <i>p</i> = 0.014 for 1994–2002; and OR 2.73; 95% CI 1.54–4.84, <i>p</i> = 0.001 for 2003–2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24–0.99, <i>p</i> = 0.048 for 1994–2002; and OR 0.32, 95% CI 0.16–0.64, <i>p</i> = 0.001 for 2003–2011). <h3>Conclusion</h3> The decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.