399 Outcome and Time Course of Recovery in Stroke. Part I: Outcome. The Copenhagen Stroke Study Henrik S. JOrgensen, AID, Hirofumi Nakayama, MD, Hans O. Raaschou, MD, JOrgen Vive-Larsen, MD, Mogens St¢ier, AID, Tom S. Olsen, MD, PhD ABSTRACT. J0rgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, St0ier M, Olsen TS. Outcome and time course of recovery in stroke. Part h outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil 1995;76:399-405. • Objective: To evaluate the outcome of stroke stratified according to both initial stroke severity and initial level of disability. Design: Prospective, consecutive, and community based. Setting: A stroke unit of a hospital in Denmark. This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the City of Copenhagen. Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age, stroke severity, and premorbid condition. Patients: 1197 patients with acute stroke. Main Outcome Measures: Primary outcome was measured as death, discharge to nursing home, or to own home. Secondary outcome was measured as neurological deficits and functional disabilities after completed rehabilitation and again 6 months after stroke onset, using the Scandinavian Neurological Stroke Scale and the Barthel Index. Results: Stroke was initially very severe in 223 (19%) of the patients, severe in 171 (14%), moderate in 316 (26%), and mild in 487 (41%) patients. Two hundred and fifty (21%) patients died during hospital stay, 177 (15%) were discharged to nursing home, and 770 (64%) patients were discharged to their own home. After completed rehabilitation, 11% of survivors still had severe or very severe neurological deficits, 11% had moderate deficits, and 78 % had no or only mild deficits; 20 % were severely or very severely disabled, 8 % were moderately disabled, 26% were mildly disabled, and 46% had no disability in activities of daily living. Detailed information on outcome stratified according to initial stroke severity/disability also is presented. Conclusions: This study provides a thorough description of the needs for stroke rehabilitation in the community and the amount of postrehabilitation disability in stroke survivors. For outcome prediction, the results can be used as a reliable tool for prognostication of the chances (or risks) of various outcomes in patients characterized by initial degree of stroke severity and/or functional disability using simple, reliable scores in the acute phase of stroke. However, the results should not be used as a guideline for selecting patients for rehabilitation in the acute phase because even the most severe cases regularly experience meaningful improvement during rehabilitation. © 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Assessing the outcome of stroke has been the objective of numerous studies. ~18 The validity of results obtained so far, however, has been restricted by several factors. These factors include small or selected study samples, inclusion of patients several weeks after stroke onset, ie, on arrival at special stroke units or rehabilitation hospitals, no informa- tion of rehabilitation therapy given, and the use of outcome measures with unknown reliability and validity. Thus, no detailed information is available regarding the outcome of an unselected, acute stroke population given organized stroke rehabilitation. Detailed knowledge of the outcome of stroke stratified according to initial stroke severity/disability is nevertheless indispensable to prognostication in the early phase of stroke, From the Departments of Neurology (Drs. J¢rgensen, Nakayama, Vive-Larsen, St¢ier, Olsen) and Radiology (Dr. Raaschou), Bispebjerg Hospital, Copenhagen, Den- mark. Supported by grants from The Danish Health Foundation, The Danish Heart Foun- dation, Ebba Celinders Foundation, and The Gangsted Foundation. Submitted for publication September 15, 1994. Accepted in revised form December 29, 1994. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to Henrik Stig Jc~rgensen, MD, The Burke Rehabilitation Center, 785 Mamaroneck Avenue, White Plains, NY 10605. © 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/95/7605-323553.00/0 to rational planning of rehabilitation and discharge place- ment, and to informing patient and family about the possibil- ity of further recovery. This information also is essential to rational health care planning. Hence, this study was undertaken to describe the recovery of stroke from the acute admission to the completion of rehabilitation or death in a large community-based stroke population. SUBJECTS AND METHODS The study population consisted of 1,197 patients with acute stroke admitted consecutively to the neurological de- partment of a hospital in Copenhagen, Denmark, during a 25-month period from September 1, 1991 to September 30, 1993 (The Copenhagen Stroke Study). Seventy percent of the patients were admitted within the first 24 hours from stroke onset, 86% within 4 days, and 93% within the first week. The study population is community based, as previously described. 19 The hospital serves a well-defined area with 239,886 inhabitants in the City of Copenhagen. All persons from the community who have an acute cerebrovascular dis- ease that requires admission to hospital are referred to and treated at the neurological department: This is regardless of the age of the patient, the severity of the stroke, and the condition of the patient before the stroke. The patients re- ceive acute treatment as well as all stages of rehabilitation Arch Phys Med Rehabil Vol 76, May 1995