Abstract 2467: Factors Affecting the Discharge Disposition after Stroke

Tseng, Hung-Pin; Liu, Chin-Hsiung; Lin, Chun‐Liang; Lin, Hung‐Chih; Chen, Pi-Tzu

doi:10.1161/str.43.suppl_1.a2467

Cited by 3 publications

(19 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, the proportion of rehabilitants returning to community was in the range of previous studies on community discharge after acute severe stroke varying from 45% 20 to 58% 18,30 to 66%, 19 in very severe stroke 36%. 18 In accordance with our results, high age 7 -9,17,19,31,32 with rare exceptions, 33,34 and high stroke severity and disability on admission to acute care (NIHSS) and on admission to subacute rehabilitation (FIM or Barthel Index) 11,13,14,17 have been found to be the most important predictors of institutionalization after acute stroke care, after rehabilitation, and at 3 months after stroke. Likewise, older age 35 and more severe stroke 35,36 at acute discharge 36 and in the first month and 3 or more months post-stroke 35 have also been found to be significant predictors for overall poor stroke outcome, functional ability, and post-stroke disposition after rehabilitation.…”

Section: Discussionsupporting

confidence: 88%

“…All other variables studied except for hypertension, that is, sex, diabetes mellitus, heart diseases, stroke history, snoring, lack of family member as a caregivers, and stroke types (main artery atherosclerosis or hemorrhage) were also found to be independent, but more modest predictors for institutionalization and gender difference disappeared in multiple logistic regression model. 17 We found that for every 1 point increase in NIHSS score on admission to rehabilitation the odds of returning home on average 2 to 3 months after stroke onset decreased with 16.1% and for every 1 year increase in age the odds of being discharged home decreased with 5.4%. Together NIHSS score and age explained 62.9% of community discharge and 74.4% of institutional discharge, the overall predictive accuracy being 69.2%.…”

mentioning

confidence: 67%

“…Together NIHSS score and age explained 62.9% of community discharge and 74.4% of institutional discharge, the overall predictive accuracy being 69.2%. Thus, it seems that NIHSS and age are highly influential predictors of discharge disposition not only after stroke care in general at 3 months 17 but also after subacute inpatient rehabilitation in rehabilitants recovering from severe stroke, the rehabilitation admission NIHSS score being superior to acute (24 hours) NIHSS in the latter setting. Rehabilitation admission NIHSS score was superior to admission FIM total score in predicting discharge destination, too.…”

Section: Discussionmentioning

confidence: 99%

“…Former studies have usually investigated predictors for discharge disposition among stroke patients or rehabilitants in general; acute NIHSS has been applied in some of these studies. 16,17 However, patients with severe stoke admitted to subacute rehabilitation may have a different set and emphasis of predictors from the overall stroke population. Few studies focus specifically on severe stroke.…”

Section: Introductionmentioning

confidence: 99%

“…NIHSS has been found to predict strongly recovery and outcome after acute stroke being superior to other stroke-specific measures. 16,49 Previous studies on discharge disposition 13,15,16 and associated factors 17,37 have examined the utility of baseline NIHSS in acute settings 13,15,37 or at 3 months from stroke onset. 16,17,49 The present study is the first one to examine the utility of rehabilitation admission NIHSS score in addition to baseline (24 hours) NIHSS in predicting community discharge in rehabilitants recovering from acute severe stroke.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination

Tarvonen-Schröder

Niemi

Koivisto

2023

Advances in Rehabilitation Science and Practice

View full text Add to dashboard Cite

Background: Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied. Aim: The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation. Material and Methods: On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression. Results: 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized. Conclusion: The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.

show abstract

Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination

Tarvonen-Schröder

Niemi

Koivisto

2023

Advances in Rehabilitation Science and Practice

View full text Add to dashboard Cite

show abstract

Predicting Discharge to Institutional Long‐Term Care After Stroke: A Systematic Review and Metaanalysis

Burton

Ferguson

Barugh

et al. 2017

J American Geriatrics Society

View full text Add to dashboard Cite

Background/ObjectivesStroke is a leading cause of disability worldwide, and a significant proportion of stroke survivors require long‐term institutional care. Understanding who cannot be discharged home is important for health and social care planning. Our aim was to establish predictive factors for discharge to institutional care after hospitalization for stroke.DesignWe registered and conducted a systematic review and meta‐analysis (PROSPERO: CRD42015023497) of observational studies. We searched MEDLINE, EMBASE, and CINAHL Plus to February 2017. Quantitative synthesis was performed where data allowed.SettingAcute and rehabilitation hospitals.ParticipantsAdults hospitalized for stroke who were newly admitted directly to long‐term institutional care at the time of hospital discharge.MeasurementsFactors associated with new institutionalization.ResultsFrom 10,420 records, we included 18 studies (n = 32,139 participants). The studies were heterogeneous and conducted in Europe, North America, and East Asia. Eight studies were at high risk of selection bias. The proportion of those surviving to discharge who were newly discharged to long‐term care varied from 7% to 39% (median 17%, interquartile range 12%), and the model of care received in the long‐term care setting was not defined. Older age and greater stroke severity had a consistently positive association with the need for long‐term care admission. Individuals who had a severe stroke were 26 times as likely to be admitted to long‐term care than those who had a minor stroke. Individuals aged 65 and older had a risk of stroke that was three times as great as that of younger individuals. Potentially modifiable factors were rarely examined.ConclusionAge and stroke severity are important predictors of institutional long‐term care admission directly from the hospital after an acute stroke. Potentially modifiable factors should be the target of future research. Stroke outcome studies should report discharge destination, defining the model of care provided in the long‐term care setting.

show abstract

Predicting institutionalization after Subacute Stroke Rehabilitation using the 12-Item World Health Organization Disability Assessment Schedule

Tarvonen-Schröder,

Koivisto

2023

JRM

View full text Add to dashboard Cite

Objective: To evaluate the utility of the 12-item World Health Organization Disability Assessment Schedule (WHODAS-12) in predicting institutionalization after subacute stroke rehabilitation.Design: Prospective observational study.Methods: On a specialized rehabilitation ward, discharge WHODAS-12 scores of 156 consecutive patients (24-h National Institutes of Health Stroke Scale (NIHSS) ≥ 15) and assessment from their proxies were compared, and receiver operating characteristic curves for predicting institutionalization were generated. Clinician-rated assessments of functioning were applied for comparison.Results: Thirty-three percent of the patients were unfit to respond, due to the consequences of major stroke. However, both patient and proxy WHODAS-12 sum scores differentiated the community (n = 70) and institution (n = 86) groups (p = 0.02 and p < 0.0001, respectively), the discriminative accuracy (area under the curve; AUC) being 0.63 and 0.79, respectively. In proxy assessments, the institutionalized patients were significantly more impaired in all item comparisons except for emotions and concentrating. Ability to participate differentiated the groups as accurately as activities (AUC 0.75 vs 0.78, respectively). The corresponding discriminative accuracy of the clinician-rated World Health Organization (WHO) minimal generic dataset sum score and modified Rankin Scale were 0.74 and 0.79 (p < 0.0001), respectively.Conclusion: Despite its brevity and subjectivity, the WHODAS-12 from proxies has shown high accuracy in predicting institutionalization after subacute rehabilitation of individuals with major stroke, the impact of participation being as relevant as that of activities. LAY ABSTRACTThis study investigated the utility of the patient- and proxy-rated 12-item World Health Organization Disability Assessment Schedule (WHODAS-12) in predicting institutionalization after rehabilitation of patients with major stroke. At discharge from rehabilitation, a median of 3 months after stroke onset, 33% of the 156 patients were not fit to respond due to the consequences of major stroke. Both of these brief measures differentiated those discharged to community from those institutionalized. WHODAS from proxies was more accurate in predicting institutionalization, and as accurate as the clinician-rated gold-standard measure, the modified Rankin Scale. Both components of WHODAS, i.e. activities and participation, were equally relevant in differentiating the 2 discharge groups. WHODAS-12 is recommended as part of individualized patient- and family-centered discharge planning after rehabilitation of patients with major stroke.

show abstract

Abstract 2467: Factors Affecting the Discharge Disposition after Stroke

Cited by 3 publications

References 0 publications

Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination

Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination

Predicting Discharge to Institutional Long‐Term Care After Stroke: A Systematic Review and Metaanalysis

Predicting institutionalization after Subacute Stroke Rehabilitation using the 12-Item World Health Organization Disability Assessment Schedule

Contact Info

Product

Resources

About