Abstract WP292: Discharge Disposition After Intracerebral Hemorrhage and Functional Outcomes
Introduction: Data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study previously reported racial/ethnic differences in discharge disposition after ICH hospitalization to home-like environments vs. medical facilities. We sought to explore how discharge disposition affects functional outcome for ICH patients with disability at time of hospital discharge.
Methods: ERICH is a multi-center, prospective case-control study of ICH among whites, blacks, and Hispanics. Patients included in this analysis had pre-stroke modified Rankin Scale (mRS) < 3, available ICH volume measurements (log transformed), and mRS of 2-5 at discharge. The mRS at 3 months post onset was the primary outcome variable. Logistic regression was used to model the probability of 3-month functional disability (mRS≥3) against discharge disposition, adjusting for ICH score and dementia.
Results: Between 08/2010 and 3/2015, 2964 ICH cases were enrolled, of whom 1627 qualified for analysis. Univariate analysis examined demographics, past medical history, social status (education level, marital status, employment), and type of insurance. In multivariate analysis, higher age, lower GCS, higher discharge mRS, non-lobar ICH location, higher ICH volume, presence of IVH, and history of dementia were independently associated with increased risk of mRS≥3 at 3 months. In a multivariate model that controlled for ICH score, patients who were mRS=3 at hospital discharge were more likely to be mRS ≥ 3 at 3 months if discharged to a medical facility rather than to home (p=.0153, OR 2.7, CI 1.2-6.2); additional independent predictors of 3-month mRS≥3 were presence of IVH (p=.002, OR 3.5, CI 1.8-6.6) and dementia (p=.04, OR 3.8, CI 1.1-13.7). However, patients who were mRS=4 at discharge were equally as likely to be mRS≥3 at 3 months, whether discharged home or to a medical facility (p=0.599, OR 0.9, CI 0.5-1.5).
Conclusion: ICH patients with moderate disability at hospital discharge were more likely to have a favorable functional outcome at 3 months if discharged to a home environment vs. a medical facility. Future analysis is needed to look at the rate of complications for ICH patients at medical facilities vs. home-like environments that may affect 3-month outcome.
Author Disclosures: J. Osborne: Research Grant; Significant; NIH NS-069763. P. Sekar: Research Grant; Significant; NIH NS-069763. C.J. Moomaw: Research Grant; Significant; NIH NS-069763. D.Y. Hwang: Other Research Support; Significant; Foundation Practice Research Training. K.N. Sheth: Other Research Support; Significant; Remedy Pharmaceuticals. C.D. Langefeld: Research Grant; Significant; NIH NS 069763. A. Vashkevich: Research Grant; Significant; NIH NS-069763. D. Woo: Research Grant; Significant; NIH NS-069763.
- © 2016 by American Heart Association, Inc.