Detection of symptoms of late complications after stroke in young survivors with active surveillance versus usual care

Abstract

Purpose

Stroke survivors develop late complications after stroke (LCAS) that impair return to pre-stroke responsibilities. Optimal strategies for detection have not been developed. We assessed differences in LCAS symptom detection among young stroke survivors undergoing active surveillance versus usual care.

Methods

This was a retrospective cohort study including patients age 18–50 with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage evaluated in a Stroke Clinic between 1/1/2016–12/31/2017 with at least one outpatient evaluation during the first year after stroke. “Active surveillance” involved a semi-structured interview to elicit LCAS symptoms including headache, seizures, lethargy, mood disorders, cognitive impairment, central pain, insomnia, spasticity, dystonia, and orthostasis. “Usual care” did not involve the interview. Rates of LCAS symptom detection were assessed at 0–3 months and 3–12 months.

Results

One hundred twenty-one stroke survivors were included, of which 37% (45) underwent active surveillance. There were no differences in baseline characteristics except hospitalization location. Patients undergoing active surveillance were more likely to have at least one LCAS symptom detected (77% vs 49% at 0–3 months, p = 0.02; 81% vs. 54% at 3–12 months, p = 0.008). Active surveillance was more likely to detect symptoms of non-motor LCAS. There were no differences for motor LCAS.

Conclusions

Active surveillance leads to higher rates of early symptom detection of non-motor LCAS in young stroke survivors.

Implications for rehabilitation

• Young stroke survivors frequently have late complications after stroke (LCAS) that impair return to pre-stroke responsibilities.

• Active surveillance for LCAS symptoms with a semi-structured interview increases detection of non-motor late complications.

• A bundled approach to screening for LCAS symptoms is pragmatic as a majority of young stroke survivors have at least one symptom but no single symptom is present in all stroke survivors.

Keywords:

• Stroke
• stroke in young adults
• outpatient
• chronic stroke
• rehabilitation
• disability

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

The dataset used in this study is available by request from the corresponding author.

Ethics approval

Approved by the IRB at Tufts Medical Center and thus this study was in accordance with the ethical standards laid out in the 1964 Declaration of Helsinki and its later amendments.

Author contributions

All authors contributed to the study conception and design. Data collection was performed by Sarah D. Gans and Elena Michaels. Analysis was performed by Sarah D. Gans and Lester Y. Leung. Interpretation of the results was performed by Sarah D. Gans, David E. Thaler, and Lester Y. Leung. The first draft of the manuscript was prepared by Sarah D. Gans and Lester Y. Leung. All authors contributed to revisions to the manuscript, and all authors approved the final version of the manuscript.