The Link Between Cerebrovascular Hemodynamics and Rehabilitation Outcomes After Aneurysmal Subarachnoid Hemorrhage.
Forrest A Brooks, Uvieoghene Ughwanogho, Galen V Henderson and 3 others
PMID 29309312WHAT IT FOUND
Early brain blood flow regulation after aneurysmal subarachnoid hemorrhage was associated with rehabilitation discharge function and recovery speed.
In 21 patients at one rehab hospital, autoregulatory range and rising slope explained up to 47% of outcome variation.
Key findings
01Patients who died before NICU discharge had a significantly smaller autoregulatory range than those discharged home or to acute rehabilitation.
02In the 21 patients admitted to Spaulding Rehabilitation Hospital, rising slope and autoregulatory range were significantly related to discharge FIM and FIM efficiency, and each explained up to 47% of the variation in rehabilitation outcomes.
03Falling slope and autoregulatory slope were not significantly related to discharge FIM or FIM efficiency, while stepwise models including SAH severity, admission FIM, and autoregulatory markers explained a majority of variation in both outcomes.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study analysed 111 of 133 admitted patients after excluding 12 discharged home with professional services and 10 with missing or insufficient hemodynamic data or unspecified discharge destination. The functional outcome analysis included only 21 of 49 patients referred to acute rehabilitation, all from one rehabilitation hospital, so the predictive models are small and may not generalise. The paper did not follow patients discharged to other rehabilitation facilities, so differences in rehabilitation care across institutions were not assessed. The study reports associations between hemodynamic markers and outcomes; it did not test whether treating autoregulation changes outcomes. The authors state they could not account for some comorbidities in the models because of small sample size. The authors state the study does not allow conclusive assessment of mechanistic links.
Declared interests
The supplied publication types indicate NIH extramural and non-U.S. government research support. No author conflict-of-interest declaration is provided in the text.
The easy way to misread this
Do not conclude that improving cerebral autoregulation will improve rehabilitation outcomes. The study measured associations, not a treatment effect, and the functional outcome analysis included 21 patients at one rehabilitation hospital.