 |
|
Prediction of Hospital Disposition After Thrombolysis for Acute Ischemic Stroke Using the National Institutes of Health Stroke Scale
Daniel J. Schlegel, MD;
David Tanne, MD;
Andrew M. Demchuk, MD;
Steven R. Levine, MD;
Scott E. Kasner, MD; for the Multicenter rt-PA Stroke Survey Group
Arch Neurol. 2004;61:1061-1064.
Background Early determination of discharge destination after acute stroke may promote earlier rehabilitation and reduce costs by shortening the duration of hospitalization.
Objective To determine whether the National Institutes of Health Stroke Scale (NIHSS) score predicts disposition in stroke patients treated with thrombolysis.
Design Cohort study.
Setting Academic and community hospitals from 3 countries.
Patients Five hundred forty-six patients with acute ischemic stroke treated with recombinant tissue plasminogen activator (rt-PA).
Interventions Medical records were reviewed for demographic information, vascular risk factors, location of stroke, initial NIHSS score, acute hospital disposition, and complications of symptomatic or asymptomatic intracerebral hemorrhage (ICH).
Main Outcome Measure Discharge destination to home, acute rehabilitation, or nursing facility.
Results In multinomial regression analysis, increasing NIHSS score was a robust and independent predictor of discharge to rehabilitation or nursing facilities, roughly doubling for each 5-point increment. Patients who developed symptomatic ICH were never discharged to home, but asymptomatic ICH had no significant independent effect on disposition.
Conclusions Stroke severity as determined by the admission NIHSS score is the major independent predictor of disposition after hospitalization and treatment with rt-PA for acute stroke in a broad-based population. However, symptomatic ICH after rt-PA is a catastrophic event that may preclude discharge to home.
From the Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania Medical Center, Philadelphia (Drs Schlegel and Kasner); Stroke Unit, Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Dr Tanne); Department of Clinical Neurosciences, Foothills Hospital, Calgary, Alberta (Dr Demchuk); and Stroke Program, Department of Neurology, The Mount Sinai School of Medicine, New York, NY (Dr Levine). A complete list of members of the Multicenter rt-PA Stroke Survey Group was published previously (Circulation. 2002;105:1684).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes
Sato et al.
Neurology 2008;70:2371-2377.
ABSTRACT
| FULL TEXT
Ability for Basic Movement as an Early Predictor of Functioning Related to Activities of Daily Living in Stroke Patients
Hashimoto et al.
Neurorehabil Neural Repair 2007;21:353-357.
ABSTRACT
Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke
Elkind et al.
Neurology 2007;68:842-848.
ABSTRACT
| FULL TEXT
Deriving Number-Needed-to-Treat and Number-Needed-to-Harm From the Saint I Trial Results
Saver
Stroke 2007;38:257-257.
FULL TEXT
Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients
Mouradian et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1234-1237.
ABSTRACT
| FULL TEXT
|
