Abstract
The purpose of this study was to determine the factors involved in predicting dependence or independence in activities of daily living (ADL) over a three-month period after the onset of ruptured aneurysmal subarachnoid hemorrhage (SAH). One hundred and fifty cases with a mean age of 60.6±11.1 years, who had been admitted to the neurosurgical unit at Kanazawa University Hospital from 1989 to 2003, were investigated. ADL at three months were scored with the Barthel Index (BI). The independent group with a BI≥85 comprised 103 cases, and the dependent group with a BI≤80 comprised 47 cases. The following were analyzed in terms of predictive value, false positive rate and sensitivity: Japan Coma Scale scores (JCS) at 2 and 4 weeks, computed tomographic (CT) findings at 4 weeks, severity of motor impairment at 4 weeks and notification of voiding at 4 weeks. Normal notification of voiding at 4 weeks was a valid predictor for the independent group (97% in terms of predictive value, with false positive rate and sensitivity scoring 4% and 69%, respectively). By contrast, moderate to severe motor impairment at 4 weeks was valid for the dependent group (97%, 1% and 68%). Though sensitivities were low, the JCS 100-300 at 2 weeks (100%, 0% and 19%) and the JCS 20, 30 a/o apallic state at 4 weeks (100%, 0% and 32%) were estimated to be specific predictors for the dependent group. These results may help in discussions at a relatively early stage of SAH regarding appropriate patient-specific rehabilitation strategies to be followed after discharge to acute phase inpatient units.
