Abstract TP379: The Relation Between Destination on Hospital Discharge and Final 3 Month Disability Outcome in Acute Ischemic Stroke
Background: The cardinal outcome measure of acute stroke clinical trials is final global disability at 3 months post-stroke. However, in routine practice it is not possible to obtain a 3 month modified Rankin Scale score in all encountered patients. The most similar variable available in administrative datasets, for use in local, regional, and national quality improvement activities, is discharge destination at end of the acute hospitalization. The relation between discharge destination and final 3 month outcome has not been previously well delineated.
Methods: We analyzed the public dataset of the two NINDS-TPA trials. Hospital discharge destination (HDCHG) was characterized as home, acute rehabilitation, skilled nursing facility, or in hospital death and handled as a 4 level ordinal variable. Hospital length of stay (LOS) was also analyzed. Final global disability at 3 months was assessed using the modified Rankin Scale (mRS). Correlation coefficients and multiple linear regression models were used to probe the relation between outcome measures.
Results: Among the 624 acute ischemic stroke patients, hospital discharge destination was home in 42.1%, acute rehabilitation in 33.0%, skilled nursing facility in 9.8%, and in hospital-death in 15.1%. A strong correlation was noted between hospital discharge destination and 3 month mRS global disability scores, r=0.71, P<0.0001. Length of stay showed a weaker correlation with 3 month mRS, r = 0.29, p <0.0001. HDCHG performed well as a single variable in predicting dichotomized 3 month mRS (independent vs dead or disabled, 0-2 vs 3-6), with c-statistic of 0.86. The multivariate model identified 9 independent predictors of 3 month global disability outcome, with HDCHG as the strongest independent variable, and LOS and the interaction term HDCHG x LOS also selected.
Conclusion: Discharge destination at the end of initial hospitalization for acute ischemic stroke is a potent predictor of final 3 month global disability outcomes. Multivariate models enable comparison of discharge destination outcomes in administrative datasets with final disability outcomes in pivotal clinical trials.
- © 2012 by American Heart Association, Inc.