Abstract TP391: Predictors of Discharge Location and Long-Term Living Destination Following Acute Care Hospitalization for Intracerebral Hemorrhage: The DECIPHER Study

Abstract

Background: The goal of this analysis was to determine factors predictive of discharge location and long-term living destination in patients following primary intracerebral hemorrhage in the DECIPHER cohort. Methods: DECIPHER is a longitudinal, multicenter, MRI-based, natural history study of racial differences in primary ICH. Inclusion criteria for this analysis were: primary ICH, age ≥ 18, signed informed consent, discharge data at baseline and year 1, and NIH Stroke Scale (NIHSS) at baseline. Clinical and demographic data were collected on all subjects. Results: There were 135 DECIPHER surviving patients who met inclusion criteria (mean age, 58 +/- 13 years; mean admission NIHSS 8 (median 5), 53% male, 76% African American). The discharge locations for subjects directly following their acute hospitalization were: 41% home, 44% acute rehabilitation, and 15% skilled nursing facility. There was no difference in discharge location by race. At year 1, 87% of subjects were at home and 13% were at a skilled nursing facility, suggesting that the patients who were discharged to acute rehab following their hospitalization were likely to be at home at the year 1 time-point. On multivariate logistic regression analysis, significant predictors of discharge to home were younger age (p=0.001), lower baseline NIHSS (p<0.001), and being married at stroke onset (p=0.001). Neither socioeconomic status nor hemorrhage volume (independent of NIHSS) entered into the predictive model. At year 1, 70% of subjects had a good functional outcome (mRS 0-2). In a predictive model of good outcome at 1 year, baseline NIHSS (p<0.001), being married at baseline (p=0.011), and age (p=0.002) were all independent predictors, however, discharge to home versus acute rehabilitation at baseline did not enter into the model. Conclusions: In the DECIPHER cohort of patients hospitalized with primary ICH, there were no significant racial differences in discharge destination. In addition to younger age, and lower NIHSS score, being married was significantly associated with discharge home vs. acute rehabilitation. Being married was also an independent predictor of good outcome at 1 year, highlighting the important role of social support in various aspects of stroke recovery.