Home-Time as a Surrogate Marker for Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Stienen, Martin Nikolaus; Smoll, Nicolas Roydon; Fung, Christian; Goldberg, Johannes; Bervini, David; Maduri, Rodolfo; Chiappini, Alessio; Robert, Thomas; May, Adrien; Bijlenga, Philippe; Zumofen, Daniel; Roethlisberger, Michel; Seule, Martin Alexander; Marbacher, Serge; Fandino, Javier; Schatlo, Bawarjan; Schaller, Karl; Keller, Emanuela; Bozinov, Oliver; Regli, Luca; ... (2018). Home-Time as a Surrogate Marker for Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke, 49(12), pp. 3081-3084. Lippincott Williams & Wilkins 10.1161/STROKEAHA.118.022808

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Background and Purpose—

Commonly used tools to determine functional outcome after aneurysmal subarachnoid hemorrhage (aSAH) have limitations. Time spent at the patient’s home has previously been proposed as a robust outcome measure after ischemic stroke. Here, we set out to validate home-time as an outcome measure after aSAH.
Methods—

We examined prospectively collected data from a nationwide multicenter registry of aSAH patients admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009–2015). We calculated mean home-time (defined as days spent at home for the first 90 days after aSAH) and 95% CIs for each category of modified Rankin Scale at discharge and 1-year follow-up, using linear regression models to analyze home-time differences per modified Rankin Scale category.
Results—

We had home-time data from 1076 of 1866 patients (57.7%), and multiple imputation was used to fill-in missing data from the remaining 790 patients. Increasing home-time was associated with improved modified Rankin Scale scores at time of hospital discharge (P<0.0001) and at 1-year follow-up (P<0.0001). Within each of the 8 participating hospitals, the relationship between home-time and modified Rankin Scale was maintained.
Conclusions—

Home-time for the first 90 days after aSAH offers a robust and easily ascertainable outcome measure, discriminating particularly well across better recovery levels at time of hospital discharge and at 1-year follow-up. This measure complies with the modern trend of patient-centered healthcare and research, representing an outcome that is particularly relevant to the patient.

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