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To determine the incidence and risk factors for medical complications in Korean patients suffering from stroke and the impact of such complications on post-stroke functional outcomes.
We assessed patients enrolled in a prospective cohort study. All recruited patients had suffered a first acute stroke episode and been admitted to nine university hospitals in Korea between August 2012 and June 2015. We analyzed patient and stroke characteristics, comorbidities, prevalence of post-stroke medical complications, and functional outcomes at time of discharge and 3, 6, and 12 months after stroke onset.
Of 10,625 patients with acute stroke, 2,210 (20.8%) presented with medical complications including bladder dysfunction, bowel dysfunction, sleep disturbance, pneumonia, and urinary tract infection. In particular, complications occurred more frequently in older patients and in patients with hemorrhagic strokes, more co-morbidities, severe initial motor impairment, or poor swallowing function. In-hospital medical complications were significantly correlated with poor functional outcomes at all time points.
Post-stroke medical complications affect functional recovery. The majority of complications are preventable and treatable; therefore, the functional outcomes of patients with stroke can be improved by providing timely, appropriate care. Special care should be provided to elderly patients with comorbid risk factors.
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To identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type.
MEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs.
The overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone.
For spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.
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To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital.
A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS).
After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident.
After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.
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A 49-year-old man received prolotherapy in the upper cervical region at a local medical clinic. Immediately after the procedure, he felt a sensation resembling an electric shock in his right upper and lower extremities, and continuously complained of numbness and discomfort in the right hemibody. He visited our clinic a week later. Upon physical examination, there were no significant abnormal findings. The visual analog scale was 60 points. T2-weight magnetic resonance images of the cervical spine showed a 0.7 cm sized bright oval spot on the right side of the spinal cord at the level of C4-C5 disc, suggesting spinal cord injury. There were no definite electrodiagnostic abnormalities. Digital infrared thermal images showed moderately decreased surface temperature on lateral aspect of the right forearm and dorsum of the right hand compared with the other side. Considering that very rare complications like spinal cord injury may develop after prolotherapy, we suggest that special interventions such as prolotherapy be performed by professional experts.
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Objective: The patients with spinal cord injury (SCI) suffered by a lot of complications that influence the quality of life both physically and mentally. The purpose of this study was to evaluate the epidemiology of patients with spinal cord injury in incidence of the complication according to the injury level and period.
Method: Retrospective study was done in 554 patients with SCI who discharged from Yonsei University Medical Center from January, 1987 to December, 1996. We investigated the incidence of each complication such as respiratory, cardiovascular, genitourinary, musculoskeletal, and dermatologic complications according to the neurologic level and each period (1987∼1991, 1992∼1996).
Results: Among the 554 cases, urologic complication (40.3%) was the most common complication followed by dermatologic (39.0%), musculoskeletal (33.6%), cardiovascular (27.1%) and so on. The most common complications of each system were autonomic dysreflexia (13.2%) in cardiovascular, pneumonia (9.6%) in respiratory, contracture (27.8%) in musculoskeletal, urinary tract infection (34.3%) in urologic, hemorrhoid in gastrointestinal, and central pain (24.0%) in neurogenic complications. The most common site of pressure sore was sacral area (58.9%). There was no significant difference in each complication according to the injury period.
Conclusion: Urologic complication was the most prevalent in patients with SCI followed by dermatologic, musculoskeletal and so on. These basic results would be helpful for prevention and management of the complication of SCI.
Objective: It has been well known that many of patients with stroke have developed secondary poststroke complications which encompassed pneumonia, urinary tract infection, depression, fall and/or fracture, deep vein thrombosis, decubitus ulcer, and others. Our experience with Korean stroke patients indicated that the incidences of such complications were not as high as reported on the western literatures. This study was aimed to obtain the precise data in terms of occurrence of poststroke complications in Korea as compared with those in western countries.
Method: Nine-hundred-eighty-four (984) charts of Stroke patients who were hospitalized at Asan Medical Center during the periods of 3 years from 1994 through 1997 were reviewed. The data from the review were compared with the data excerpted from the literatures.
Results: The review of charts disclosed that there was a great disparity of the incidences of complications in stroke patients between Korea and Western (U.S.A.) countries. The incidences of all stroke complications were uniformly much lower in Korea than Western countries.
Conclusion: Compared with western countries, stroke patients in Korea presented significantly lower incidences of poststroke complications: 5.8% pneumonia; 3.7% urinary tract infection; 3.0% fall; 2.7% decubitus ulcer; and 2.4% deep vein thrombosis. Although there were a many factors accounting for lower incidences of complication, an extensive nursing service around the clock seemed to be a major attributing factor. However, the nursing services such as position change, massage, joint motion exercise etc. have been rendered not by registered nurse but by a caregiver hired by patient's family or a member of patient's family. Since patient's family or caregiver had not formally received an education of health care, their service may be liable for incidences against patient's quality care. Therefore, the strengthening of the manpower of registered nurse is essential to meet a standard of nursing service.
Spinal manipulative therapy is frequently prescribed for back and neck pain. Though most persons practicing manipulation insist that spinal manipulative therapy is a safe treatment, serious complications could occur. It is essential to be aware of these complications in prescribing or practicing prreting manipulative therapy. We report one case of cauda equina syndrome caused by spinal manipulative therapy with review of literatures.
Method: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy.
Results: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic compli cations. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy.
Conclusion: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.
Method: Initial and follow up electrodiagnostic data of 100 patients who had been diagnosed as spina bifida were obtained retrospectively. Electrophysiological diagnosis and neurological level were investigated by the findings of needle electromyography. Each patients were divided into no change, improvement and deterioration group according to follow up study. The change of urodynamic study findings and clinical findings were also investigated. The recent functional outcomes and the presence of complications were evaluated by recent outpatient record.
Results: 56 patients had no change, 15 patients had improvement and 29 patients had deterioration electrophysiologically. The initial electrodiagnostic findings were associated with the functional outcomes in patients with spina bifida (p＜0.05). However, neurological level by electrodiagnostic findings cannot predict functional outcomes except ambulation activities. The change of electrodiagnostic findings of follow up study were related with the change of clinical findings statistically (p＜ 0.05).
Conclusion: Follow up electrodiagnostic study as well as initial study is necessary for the evaluation of the change of neurological states in the patients with spina bifida.
Objective: The risk of barium aspiration has been reported through animal and clinical studies. Although the barium aspiration occurs frequently during videofluoroscopic barium swallowing study (VFSS) that is used in a standard method for diagnosis of dysphagia, there has been no research about the risk of VFSS.
Method: One hundred VFSS of sixty nine patients were analyzed prospectively. The patients were diagnosed to dysphagia clinically. VFSS findings were classified into 5 groups according to the severity of aspiration. The incidences of complications, such as fever (＞38.3oC), leukocytosis (＞10,000), dyspnea and abnormality of chest roentgenogram within 24hours after VFSS were determined in each group. Odds ratios of complications after VFSS for severity of their findings were calculated.
Results: The complications of VFSS are as follows; five febrile conditions, three leukocytosis and three dyspnea among 100 VFSS cases. Odds ratios for complications were over 1 except for the abnormality of chest roentgenogram, but which was not statistically significant.
Conclusion: The incidence of complication after VFSS was 5% in dysphagic patients. But the severity of complication was mild and there was no statistical significance between complication and aspiration on VFSS, so VFSS was a relatively safe procedure.
Objective: To evaluate clinical features in general and possible complications in Duchenne muscular dystrophy (DMD) which could be used for comprehensive rehabilitation management.
Method: One hundred and seventy-two patients with DMD were followed over 3 year period to provide clinical profile causing impairment and disability. We measured height, weight and manual muscle testing (MMT) when the patients visited the hospital. And we could measure pulmonary function, electrocardiogram (EKG), and intelligence quotient (IQ) test in cooporative patients.
Results: The median height and weight of DMD boys were normally distributed before age 12, but during the second decade height was markedly reduced, and weight was no longer normally distributed. The MMT measurement showed loss of strength in a fairly linear fashion according to increasing age, and extensor of lower extremities were weaker than flexors showing typical contractures of legs. There was a direct relationship between pulmonary function and MMT scores of upper extremities. There was a high occurrence (40%) of abnormal EKG, but none of the patients had a history of cardiovascular complication. DMD children suffered wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression, and 50.9% of them were below average on the IQ test.
Conclusion: These data on DMD subjects provide clinicians with useful information regarding the prevalence and severity of measurable impairment at different stages of the disease.
Objective: To investigate complications of stroke patients with regard to incidence, predisposing risk factors and their effect on the patients's prognosis during rehabilitation management.
Method: Two hundred fifty nine patients with stroke admitted to Department of Rehabilitation Medicine were included in this study. We analyzed types of stroke, incidence of complications, outcome of rehabilitation treatment and the length of the hospital stay.
Results: Of the 259 patients who had received rehabilitation, shoulder pain occurred in 59 patients (22.8%), depressions in 24 (9.3%), falls in 24 (9.3%) and pneumonia in 21 (8.1%); 112 patients (42.9%) had a total of 174 complications. The incidence of complication was higher in patients who had lower initial FIM score or previous cardiac disease. The patients with complication had longer rehabilitation hospital stay and lower FIM gain and efficacy.
Conclusion: Early detection and treatment of the complications of acute stroke patients during rehabilitation will shorten the length of the hospital stay and improve the overall prognosis of the patients.
Objective: Nasogastric (NG) tube feeding and percutaneous endoscopic gastrostomy (PEG) feeding have been used for dysphagic patients as tube feeding methods. In 1988, Campbell introduced oro-esophageal (OE) tube feeding as a new feeding method, but there are no reports of safety or complications of this method.
Method: The patients 1) who could not do oral feeding and reject other tube feedings, or started oral feeding but could not be provided enough calories by this methods, 2) who had the reduced gag reflex, and 3) who had intact cognitive functions, were applied OE tube feeding and twenty patients from March 1998 to May 1999 were selected and followed up. We retrospectively reviewed their average using time, final feeding methods and complications of long term OE tube feedings.
Results: The average using time was 74⁑107 days. 13 patients used OE tube feedings continuously, and seven changed their feeding methods (two used NG tube feedings, one PEG, and 4 oral feedings). Only one patient was developed aspiration pneumonia, so he was prescribed for NG tube feeding, but others had no problems such as diarrhea.
Conclusion: The complication rate of OE tube feeding was 5%, and it was relatively safe for long term users.
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