Abstract TP405: Can Discharge Rankin Be Used As A Surrogate For 30-day Functional Outcomes?
Functional status after stroke is a critical outcome measurement, although there are significant logistical issues with systematically obtaining this information after hospital discharge.
Objective: To determine agreement between discharge Rankin (dRankin) and 30-day phone Rankin to explore the feasibility of using dRankin as a surrogate for 30day outcomes after stroke.
Methods: Prospective cohort study of patients admitted for stroke at 6 hospitals participating in the Ohio Coverdell Outcomes Evaluation Project. dRankin was determined retrospectively and 30d Rankin was assessed prospectively by phone (5 hospitals) or post discharge visit (1 hospital). Patients who died or had hospice care prior to discharge were excluded.
Results: Discharge and 30d Rankins were available in 368 subjects. Mean age was 68.8 yrs and 78.0% were white. Mean dRankin was 2.75 and 30d Rankin was 2.27. There was perfect agreement between dRankin and 30dRankin in 28.8% cases, which improved to 71.4 % when 30dRankin was dichotomized into non-disabling (0-2), disabling stroke/death (3-6). Differences in scores were due to improvement in 82.9% cases (Figure). For patients with disabling stroke at discharge (dRankin3-5), improvement at least 1 grade occurred more frequently in those discharged home without HHC (84.4%) or to acute rehab (73.8%) compared to other destinations. There was little difference in those with non-disabling or disabling stroke who improved >=1 grade according to multiple variables including sex, age, race, NIHSS, insurance, various comorbid conditions and IV tPA use.
Conclusion: There was moderate agreement between dRankin and 30d Rankin when dichotomized into non-disabling (0-2) vs disabling stroke/death (3-6). Agreement was marginal at the individual score level, mostly due to improvement postdischarge. More evaluation will be needed to identify factors associated with improved scores if dRankin is used as a surrogate for postdischarge functional status.
- © 2012 by American Heart Association, Inc.