Ischemic and hemorrhagic strokes in young adults: Comparison of functional outcomes and return to work after stroke

Sarah Ming Li Tan; Shi Hui Ong; Tseng Tsai Yeo; Vincent Diong Weng Nga; Effie Chew; Pui Kit Tam; Peijing Su; Megan Bj Ng; Hui Shi Lim; Leonard Ll Yeo; Vijay K Sharma; Ching-Hui Sia; Mervyn Jun Rui Lim; Benjamin Yong-Qiang Tan

doi:10.1016/j.clineuro.2023.107964

Ischemic and hemorrhagic strokes in young adults: Comparison of functional outcomes and return to work after stroke

Clin Neurol Neurosurg. 2023 Oct:233:107964. doi: 10.1016/j.clineuro.2023.107964. Epub 2023 Sep 7.

Authors

Affiliations

¹ Division of Neurology, Department of Medicine, National University Health System, Singapore.
² Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³ Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore.
⁴ Division of Rehabilitation Medicine, Department of Medicine, National University Hospital, Singapore.
⁵ Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁶ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore.
⁷ Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: benjaminyqtan@gmail.com.

PMID: 37717357
DOI: 10.1016/j.clineuro.2023.107964

Abstract

Background: Functional recovery and return to work (RTW) after stroke are important rehabilitation goals that have significant impact on quality of life. Comparisons of functional outcomes and RTW between ischemic stroke (IS) and hemorrhagic stroke (HS), especially among young adults with stroke, have either been limited or yielded inconsistent results. We aimed to assess functional outcomes and ability to RTW in young adults with IS and HS, specifically primary spontaneous intracranial hemorrhage (SICH).

Methods: Young adults with IS or SICH aged 18-50-years-old were included. Outcome measures were modified Rankins score (mRS) on discharge and 3-months and RTW at 3-months after stroke. Good functional outcome was defined as an mRS of 0-2.

Results: We included 459 patients (71.5% male) with a mean age of 43.3 ± 5.7 years, comprising 49.2% IS and 50.8% SICH. Patients with SICH were more likely to have unfavourable shifts in ordinal mRS on discharge (OR 7.52, CI 5.18-10.87, p < 0.001) and at 3-months (OR 6.41, CI 4.17-9.80, p < 0.001). Patients with IS more likely achieved good functional outcomes (80.2% vs. 51.8%, p < 0.001) and were able to RTW at 3-months (54.4% vs. 36.3%, p = 0.004). Among all stroke patients with good functional outcomes, one-third did not RTW at 3-months. Patients with longer length of hospitalisation and higher National Institutes of Health Stroke Scale (NIHSS) score on admission, especially in the domain categories of level of consciousness, vision, motor function, language and neglect, were less likely to RTW at 3-months.

Conclusion: Patients with IS were more likely to RTW when compared to SICH patients. Many young stroke patients did not RTW despite good functional outcomes. Further research should therefore address differences in prognosis and identify predictors that influence ability to RTW after stroke in the young adult population.

Keywords: Functional outcomes; Hemorrhagic stroke; Ischemic stroke; Risk factors; Young adults.