ORIGINAL ARTICLES   Free

Europa Medicophysica 2001 September;37(3):153-9

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

Ictus, comorbidity and outcome: the role of the indwelling bladder catheter

Iona L. G., Varnier A., Bianchi L., Polentarutti S., Deotto E.

From the U. O. Riabilitazione, Azienda Ospedaliera «Santa Maria della Misericordia», Udine

Back­ground. ­Acute ­phase ­stroke ­care rep­re­sents a ­major com­po­nent in reha­bil­i­ta­tion ­stroke ser­vices. Con­strained by lim­ited ­access to ­resources, hos­pi­tals ­have had to ­apply selec­tion cri­teria to iden­tify sub­jects ­that ­could poten­tially ben­efit ­most ­from treat­ment. ­Common prog­nostic fac­tors in ­patient selec­tion are age, ­site and ­severity of the ­lesion, comor­bid­ities, ­impaired cog­ni­tion, uri­nary incon­ti­nence and albu­menia ­levels. We ­decided to ­verify the prog­nostic ­value of sev­eral of ­these var­i­ables and comor­bid­ities.
­Methods. A ­series of 117 ­patients con­sec­u­tively ­admitted to our reha­bil­i­ta­tion ­unit ­from ­June 1999 to May 2000 ­with diag­nosed hem­i­par­esis or hem­i­plagia in ­stroke ­were ­assessed. ­Within 24 ­hours ­from admis­sion to our ­unit the ­patients ­received ­thorough clin­ical assess­ment, rou­tine ­blood chem­istry ­tests (hemo­chrome, gly­cemia, pro­tei­nemia, albu­mi­nemia) and func­tion eval­u­a­tion, com­prising ­Mini ­Mental ­State (MMS), Bar­thel ­Index (BI), Func­tional Inde­pen­dence ­Measure (FIM), and ­Face ­Scale (FS). All func­tion ­tests ­were ­repeated on dis­charge.
­Results. Albu­mi­nemia ­levels ­showed a pos­i­tive cor­re­la­tion ­with MMS, BI and ­motor and cog­ni­tive FIM sub­scales, ­whereas no sig­nif­i­cant cor­re­la­tions ­were ­found ­with FS ­scores. On dis­charge the ­only ­remaining pos­i­tive cor­re­la­tion was ­between albu­mi­nemia ­levels on admis­sion and cog­ni­tive FIM sub­scale ­scores. Sta­tis­ti­cally sig­nif­i­cant pos­i­tive cor­re­la­tions ­were ­found ­between the ­number of comor­bid­ities and ­length of ­stay (LOS; r=0.35, p<0.001; ­Spearman’s rho 0.38, p<0.001) and dis­ability ­scales.
Con­clu­sions. ­Given the impor­tance of neg­a­tive prog­nostic fea­tures ­such as ­initial ­severity of the dis­ability, age, nutri­tional ­state and pres­ence of ind­welling cath­eter, reha­bil­i­ta­tion ­efforts ­must be ­directed ­toward a ­more appro­priate man­age­ment of mic­tu­rion dys­func­tion ­which ­includes ­removal of the ind­welling cath­eter. ­This indi­ca­tion is ­based on our obser­va­tion ­that in our ­case ­series ­greater atten­tion to the die­tary pro­gram ­reduced the prog­nostic ­weight of hypo­al­bu­mi­nemia.