Abstract WP367: Evaluation of Stoke Severity Using NIHSS as a Predictor for Readmissions in a Veteran Population

Abstract

Background and Issues: Stroke is a leading cause of death and results in readmissions up to 20-27% within the first 1 year. The National Institute of Health Stroke Scale (NIHSS) is a score used to quantify stroke severity (higher being more severe). Mixed data exist as to whether this score can predict readmission. Purpose: The purpose of this study was to assess the NIHSS score as a predictor for readmission rates and whether higher NIHSS scores are associated with 30-day readmission rates. Methods: This IRB-approved retrospective chart review included patients admitted to the VA Loma Linda Healthcare System for ischemic stroke, hemorrhagic stroke, or a transient ischemic attack from June 2015-July 2016. Patients were excluded if they had other neurologic diagnoses or if care was transferred to another institution. Data collected included demographics, NIHSS score at index stroke, comorbidities, time interval to readmission, and readmission diagnosis. Statistical analyses included Student’s T-test and Fisher’s exact for assessing NIHSS as a continuous and categorical (mild vs moderate/severe) predictor respectively. Results: Among 72 stroke patients, 16 patients were readmitted. There was no difference in the mean NIHSS of readmitted vs. non-readmitted patients (2.56 (2.71) vs 2.55(2.97)). Patients with moderate/severe NIHSS had higher readmission rates compared to those with mild NIHSS, but this was not statistical significant (40% vs. 21%; P=0.31). However, patients readmitted within 30 days had a significantly higher mean NIHSS than those readmitted >30 days (3.58 vs 1.53; 95% CI=0.52-4.12; P=0.014). There was no significance in readmission based on discharge disposition or administration of tissue plasminogen activator. Conclusions: Patients readmitted within 30 days of index stroke had higher NIHSS scores and therefore more severe stroke symptoms. There was a trend that patients with moderate/severe NIHSS scores were more likely to be readmitted, but this was not significant. Collectively these finding indicate NIHSS may be important for predicting readmissions.