Evidence map›Paper›PMID 36450972›Full record

ArticleNeurocritical care2023

Long-Term Outcomes of Patients with Stroke Predicted by Clinicians to have no Chance of Meaningful Recovery: A Japanese Cohort Study.

Satoshi Egawa, Jeremy Ader, Qi Shen, Shun Nakagawa, Yoshihisa Fujimoto, Shuichi Fujii, Kenta Masuda, Akira Shirota, Masafumi Ota, Yuji Yoshino and 14 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurocritical care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.6field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 5 citations in OpenAlex.

  1. Review
  2. Observational
  3. Observational
  4. Review
  5. Prognosis of consciousness disorders in the intensive care unit.Presse medicale (Paris, France : 1983) · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors at 2 institutions in 2 countries.

Satoshi Egawa *Department of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Jeremy Ader *Department of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Qi ShenDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Shun NakagawaDepartment of Neurointensive Care, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Yoshihisa FujimotoDepartment of Neurointensive Care, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Shuichi FujiiDepartment of Neurointensive Care, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Kenta MasudaDepartment of Rehabilitation, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Akira ShirotaDepartment of Rehabilitation, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Masafumi OtaDepartment of Rehabilitation, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Yuji YoshinoDepartment of Rehabilitation, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Hitomi AmaiDepartment of Social Work, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Satoru MiyaoDepartment of Neurosurgery, Stroke and Epilepsy Center, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Hidetoshi NakamotoDepartment of Neurosurgery, Stroke and Epilepsy Center, Toda Medical Group Asaka Medical Center, Saitama, Japan.
Yasuhiro KurodaEmergency Medical Center, Kagawa University Hospital, Kagawa, Japan.
Kevin DoyleDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Lauren GroboisDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Athina VrosgouDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Jerina C CarmonaDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Angela VelazquezDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Shivani GhoshalDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
David RohDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Sachin AgarwalDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Soojin ParkDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Jan ClaassenDepartment of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA. jc1439@columbia.edu.ORCID http://orcid.org/0000-0002-5893-8531
NewYork–Presbyterian Hospital · USKagawa University Hospital · JP

Funding

RECONFIG - REcovery of CONsciousness Following Intracerebral hemorrhaGeR01NS106014 · NINDS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI CLAASSEN, JAN · 2019 to 2023
$3.6M
BAsIC - Brain-computer-interface practical Application in the Intensive Care unit: a pilot studyR03NS112760 · NINDS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI CLAASSEN, JAN · 2019 to 2020
$162k
NINDS NIH HHS R01 NS106014NINDS NIH HHS R03 NS112760
6 · The paper itself

Abstract

backgroundLittle is known about the natural history of comatose patients with brain injury, as in many countries most of these patients die in the context of withdrawal of life-sustaining therapies (WLSTs). The accuracy of predicting recovery that is used to guide goals-of-care decisions is uncertain. We examined long-term outcomes of patients with ischemic or hemorrhagic stroke predicted by experienced clinicians to have no chance of meaningful recovery in Japan, where WLST in patients with isolated neurological disease is uncommon.

methodsWe retrospectively reviewed the medical records of all patients admitted with acute ischemic stroke, intracerebral hemorrhage, or nontraumatic subarachnoid hemorrhage between January 2018 and December 2020 to a neurocritical care unit at Toda Medical Group Asaka Medical Center in Saitama, Japan. We screened for patients who were predicted by the attending physician on postinjury day 1-4 to have no chance of meaningful recovery. Primary outcome measures were disposition at hospital discharge and the ability to follow commands and functional outcomes measured by the Glasgow Outcome Scale-Extended (GOS-E), which was assessed 6 months after injury.

resultsFrom 860 screened patients, we identified 40 patients (14 with acute ischemic stroke, 19 with intracerebral hemorrhage, and 7 with subarachnoid hemorrhage) who were predicted to have no chance of meaningful recovery. Median age was 77 years (interquartile range 64-85), 53% (n = 21) were women, and 80% (n = 32) had no functional deficits prior to hospitalization. Six months after injury, 17 patients were dead, 14 lived in a long-term care hospital, 3 lived at home, 2 lived in a rehabilitation center, and 2 lived in a nursing home. Three patients reliably followed commands, two were in a vegetative state (GOS-E 2), four fully depended on others and required constant assistance (GOS-E 3), one could be left alone independently for 8 h per day but remained dependent (GOS-E 4), and one was independent and able to return to work-like activities (GOS-E 5).

conclusionsIn the absence of WLST, almost half of the patients predicted shortly after the injury to have no chance of meaningful recovery were dead 6 months after the injury. A small minority of patients had good functional recovery, highlighting the need for more accurate neurological prognostication.

Indexed as

Ischemic StrokeStrokeSubarachnoid HemorrhageAgedCerebral HemorrhageCohort StudiesEast Asian PeopleFemaleHumansMaleRecovery of FunctionRetrospective StudiesJapanOutcomePrognosticationStrokeWithdrawal of life-sustaining therapy

Identifiers

PMID36450972
PMCPMC10227183
OpenAlexW4310443940

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.