Published Online
on November 29, 2004

A more recent version of this article appeared on January 1, 2005

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Submitted on September 1, 2004
Revised on October 13, 2004
Accepted on October 19, 2004

Optimizing Discharge Planning. Clinical Predictors of Longer Stay After Recombinant Tissue Plasminogen Activator for Acute Stroke

Gustavo Saposnik MD, MSc^*; Fiona Webster MA; Chris O’Callaghan BAppSc; and Vladimir Hachinski MD, DSc, FRCPC

From the Stroke Program, Department of Clinical Neurological Sciences and Southwestern Ontario Coordinated Stroke Strategy, London Health Science Center, The University of Western Ontario, London, Ontario.

^* To whom correspondence should be addressed. E-mail: gsaposni{at}uwo.ca.

Background and Purpose--The length of stay (LOS) is the main cost-determining factor for inpatients with acute stroke. Although studies have identified variables associated with LOS, few have analyzed predictors of longer stay after receiving thrombolytic therapy for acute stroke.

Methods--We studied all consecutive acute stroke patients receiving intravenous recombinant tissue plasminogen activator (rtPA) admitted to the London Health Sciences Center, in London, Ontario, Canada, from 1999 to 2003. Longer stay was defined as LOS 7 days after admission. Demographic as well as baseline clinical, laboratory, and imaging variables were analyzed to identify predictors of LOS. Significant variables were entered into a multivariate logistic regression analysis.

Results--Among 216 acute stroke patients receiving rtPA, the median LOS was 6 days. LOS was >7 days in 102 (49%) patients. Age 70 (odds ratio [OR], 2.2; 95% CI, 1.2 to 4.0), lack of improvement at 24 hours (OR, 2.5; 95% CI, 1.4 to 4.4), prestroke modified Rankin Scale 2 (OR, 2.4; 95% CI, 1.2 to 4.9), baseline National Institutes of Health Stroke Scale score 15 (OR, 9.4; 95% CI, 3.2 to 27.6), cortical involvement (OR, 2.2; 95% CI, 1.2 to 3.9), and new infarction on the control computed tomography (CT; OR, 2.8; 95% CI, 1.4 to 5.9) were independent predictors of longer stay.

Conclusions--Lack of improvement at 24 hours after rtPA, cortical involvement, and new infarction on the 24-hour CT scan are relevant variables that can independently affect the LOS. These new variables may be useful for establishing policy in relation to the organization and planning of the health care system.

Key words: complications • hospitalization • outcome • prognosis • stroke • thrombolytic therapy • tissue plasminogen activator

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