ObjectiveThe aim of the study was to identify causes for readmission to acute care of patients admitted to inpatient rehabilitation facility after stroke.DesignThe institutional Uniform Data System for Medical Rehabilitation database was used to identify stroke patients who experienced readmission to acute care and an equal number of age-/sex-matched group of patients who successfully completed their inpatient rehabilitation facility stay during 2005–2018. Retrospective chart review was used to extract clinical data. The two study groups were compared using univariate and multivariate analyses.ResultsThe rate of readmission to acute care was 4.7% (n = 89; age = 65 ± 14 yrs; 37% female; 65% White; 73% ischemic stroke). The most common indications for transfer were neurological (31%) and cardiovascular (28%). Compared with control group, the readmission to acute care group had statistically higher rates of comorbid conditions, lower median (interquartile range) Functional Independence Measure score on inpatient rehabilitation facility admission (55 [37–65] vs. 64 [51–78], P < 0.001), and a higher rate of sedative/hypnotic prescription (82% vs. 23%, P < 0.001).ConclusionsReadmission to acute care is not common in our cohort. Patients who experienced readmission to acute care had higher medical complexity and were prescribed more sedative/hypnotic medications than the control group. Practitioners should be vigilant in patients who meet these criteria.

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Introduction Low back pain is a leading disability worldwide; however, it is not often the result of a serious underlying condition such as a tumor. As a result, diagnosis of a serious underlying cause of low back pain may be delayed, such as in this case. Case presentation We describe a case of a man presenting with low back pain, who was eventually diagnosed with solitary bone plasmacytoma (SBP) causing spinal cord compression from approximately T7-T9. The patient was classified as T8 ASIA C-Incomplete Paraplegia. He underwent an emergency T7-T9 open posterior laminectomy and resection of the epidural mass/tumor. Following an intensive course of rehabilitation treatment, the patient progressed to ASIA D. Discussion Although SBP of the spine is rare, back or neck pain is a common initial presentation. This case is unique in that we provide a detailed description of both medical and rehabilitation diagnosis and treatment. We also suggest that persistent back pain warrants complete MRI spinal imaging to provide proper diagnosis and prompt treatment for cases with a serious underlying condition.

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Introduction: Reducing readmission rate is a healthcare priority. The aim of this project is to examine factors associated with readmission after stroke in a privately insured cohort. Methods: Our organization is a health insurance provider as well as a healthcare provider. We retrospectively identified members of our insurance plan who discharged from one of our family of hospitals (one comprehensive stroke center, one primary stroke center, and two stroke ready hospitals) 2014-2018 with a stroke diagnosis. Using insurance claims, we captured all readmissions and ER visits in the 30 days after discharge. Using the same data, we were also able to identify primary care visits in the year preceding and the month following the index stroke. The impact of primary care was examined in a univariate analysis and a multivariate analysis adjusting for age, sex, race, stroke type, and length of stay (LOS). Results: We identified 1177 patients after excluding those who were not members of our insurance plan and those who had a planned admission such as to inpatient rehab (mean age 71±15 years; 53% women; 17% non-white). Stroke types were 72% ischemic stroke; 12% TIA; 7% ICH; 4% SAH. Most common discharge destination was home 68% followed by skilled nursing facility 27%. Overall 30-day all-cause readmission rate was 31% (21% inpatient admission, 8% ER visit, and 2% both). In an unadjusted model, there was a significant association between number of primary care visits and probability of readmission (OR 0.60 [95% CI 0.50-0.72]; p<0.0001). This association remained significant in the multivariate analysis (OR 0.73 [95% CI 0.58-0.91]; p=0.005). Other variables independently associated with readmission include age, LOS, and ischemic type of stroke. There was no association between readmission and sex or race and no interaction between primary care and sex nor between primary care and race. Conclusion: Established primary care is protective from stroke readmission. In high risk patients (older age with ischemic stroke and prolonged length of stay), efforts should be made to arrange for primary care sooner than later.

Longitudinal myelitis secondary to an acute flare of systemic lupus erythematosus has been reported in the literature. There have been few published cases of complete functional recovery in patients with systemic lupus erythematosus–related longitudinal myelitis (systemic lupus erythematosus–related longitudinal myelitis). Of those cases, none have described in detail the rehabilitation course of treatment. In the current case, intensive rehabilitation was coupled with aggressive pharmaceutical treatment resulting in almost full functional recovery. A 23-yr-old African American woman with a history of systemic lupus erythematosus was originally admitted as an inpatient for flank pain. Overnight, she progressed rapidly to complete flaccid paraplegia classified as T3 American Spinal Injury Association Impairment Scale A based on the International Standards for Neurological Classification of Spinal Cord Injury. Throughout the next year, she participated in acute inpatient rehabilitation, followed by outpatient rehabilitation (physical, occupational, and aquatic therapies). A year after her initial hospital admission, she progressed to full community ambulation T3 American Spinal Injury Association Impairment Scale D. This case illustrates the importance of proper medical treatment and a comprehensive rehabilitation program, which improved functional outcomes for a patient with a complete spinal cord injury due to systemic lupus erythematosus–related longitudinal myelitis.

Objective The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. Design Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days (n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls (n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. Results Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. Conclusions Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.

Introduction: Several tools have been developed aimed at predicting large vessel occlusion (LVO) in the prehospital setting. If these tools are used to bypass Alteplase-but-not-thrombectomy-capable hospitals, this would speed the care for some patients, delay it for others, and unnecessarily redistribute some patients between hospitals. Methods: We examined a hypothetical scenario of 1,000 patients evaluated by EMS for possible stroke. We used data published by RACE (Rapid Arterial oCclusion Evaluation) that included 357 patients to calculate the rates of the different stroke subtypes. Ischemic stroke represented 67.2% of patients, hemorrhagic stroke 14.6%, transient ischemic attack 5.6%, and stroke mimic 12.6%. We applied the following assumptions: rate of LVO as 20% of total ischemic stroke, all patients evaluated by EMS within 3 hours from their last known well time with a rate of tPA utilization is 50%, endovascular-capable hospital is further away, similar door-to-needle (DTN) time in all hospitals, delay in DTN in false positive patients, and delay in door-to-groin time (DTG) in false negative patients. Seven tools were studied using published values for sensitivity and specificity. Results: Using no tools would lead to evaluation of all patients at the nearer hospital first, leading to delay in DTG of all 134 LVO patients, however no delay in DTN. Comparing the various tools, DTN delay would be highest with Cincinnati Prehospital Stroke Severity Scale (CPSSS; n=175) and least with 3-item stroke scale (3I-SS; n=23). DTG delay would be highest with Prehospital Acute Stroke Severity (PASS) and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) (n=52 for both) and least with RACE (n=20). Redistribution of patients would be highest with CPSSS and lowest with 3I-SS (reduction in patient volume to non-thrombectomy capable hospital 63% and 16% respectively and increase in volume for the thrombectomy-capable hospital by 371% and 19% respectively). Conclusion: Current tools have a very wide variation in performance. Although some tools would likely reduce the delay in DTG time for most (but not all) LVO patients, they risk delaying care for other patients and may cause an unnecessary redistribution of patients between hospitals.