Abstract 120: Predictive Validity of Barthel Index Compared to NIHSS for Discharge Destination Following an Acute Stroke Hospitalization
Introduction: Clinical practice guidelines recommend all stroke patients receive a brief functional assessment to help determine need for rehabilitation services. However, the value of a standardized functional assessment for determining rehabilitation service need is unclear. This study evaluated the predictive validity of the Barthel Index (BI) compared to admission NIHSS for predicting discharge to institution-based rehabilitation vs. home, and discharge to inpatient rehabilitation (IRF) vs. skilled nursing facilities (SNF).
Methods: We analyzed data from a Northeast Cerebrovascular Consortium feasibility study of 22 Get With The Guidelines-Stroke participating hospitals that completed a standardized assessment including NIHSS and BI. Patients with TIA or who died in hospital, left AMA, or were discharged to another acute hospital or hospice were excluded. Multivariable logistic regression was used to examine BI scores (in quintiles) with discharge to institution-based rehabilitation (IRF or SNF) vs. home, and discharge to IRF vs. SNF. Models were repeated for NIHSS in place of the BI.
Results: Among the 792 eligible stroke patients, mean age was 69±15 years, 51% were female, 54% had Medicare insurance, 89% had an ischemic stroke, and 61% were independent pre-stroke (modified Rankin scale score=0-1). After accounting for these factors, the highest two BI quintiles (85-100 and 65-80 compared to 0-20=severely impaired) were independently associated with discharge to institution-based rehabilitation compared to home (OR=0.01, 95%CI=0.003-0.02 and OR=0.06, 95%CI=0.03-0.14, respectively) and explained 90.2% of the variance. NIHSS score was also associated with discharge to institution-based rehabilitation (OR=0.18, 95% CI 1.14-1.23) and the model explained 82.3% of the variance. BI was not associated with discharge to SNF vs. IRF (p>0.1, c=0.763) and NIHSS was (OR=1.06, 95%CI=1.02-1.11, c=0.80) after accounting for patient-level factors.
Discussion: The predictive validity of BI was better than NIHSS for discharge to institution-based rehabilitation compared to home. NIHSS but not the BI predicted discharge to SNF vs. IRF. Research is needed to help direct survivors to the appropriate level--IRF or SNF--rehabilitation care.
- © 2012 by American Heart Association, Inc.