Abstract
Discharge status and acute re-hospitalization are used as indicators of stroke severity and recovery. Intravenous t-PA (tissue plasminogen activator) is one of two treatments shown to have a positive impact. Stroke rehabilitation patients are an important population who will end up integrated back into the community, institutionalized or hospitalized due to late stroke complications. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy. Retrospective analysis of census data from ischemic stroke patients on the UTHealth Stroke/Neurorehabilitation Services at Memorial Hermann Hospital - Texas Medical Center between Jan 2011 and Nov 2013, discharged to the Community, SNF (Skilled Nursing Facility) or AC (Acute Care). Demographics and NIHSS (National Institutes of Health Stroke Scale) were collected. Discharge FIM (Functional Independence Measure) was the reference standard. Genitourinary infections were a negative mediator in the multivariate regression. Of 346 patients, 274 returned to the community, 47 to SNF, and 25 to AC. Median NIHSS values were 8 in the community group, 11 in SNF and 9.5 in AC. 31.8% of patients received IV t-PA in the community group, 23.4% in SNF and 24% in AC. There were no statistically differences in community discharge rates. One day increase in rehabilitation hospitalization correlated with 19% decreased odds of AC readmission (OR 0.81; P=0.001). One unit discharge FIM increase correlated with 13% decreased odds of AC readmission (OR 0.87; P=0.003). One year age increase correlated with 4% increased odds of SNF admission (OR 1.04; P=0.02). Intense rehabilitation evidenced by FIM improvement and length of stay, impacts community discharge in mild to moderate stroke patients. t-PA had no effect. This study is limited by sample size, retrospective design and undetermined psychosocial factors.
Highlights
Cerebrovascular disease is the leading cause of disability in the United States, costing an estimated $36.5 billion annually [1]
Intense rehabilitation evidenced by FIM improvement and length of stay, impacts community discharge in mild to moderate stroke patients. t-PA had no effect
The purpose of this study is to determine whether intravenous thrombolysis with t-PA and the subsequent improvement in NIHSS can predict community discharge after inpatient rehabilitation
Summary
Cerebrovascular disease is the leading cause of disability in the United States, costing an estimated $36.5 billion annually [1]. To curb cost and decrease disability rates, iterations of outcomes research are of critical importance, related to post-acute rehabilitation care. In 1995, the NINDS [National Institute of Neurologic Disorders and Stroke] and Stroke t-PA (tissue plasminogen activator) trial showed improved functional outcomes at three months in patients treated with t-PA compared to placebo [2]. Efforts to quantify the impact of intravenous thrombolysis on the need for inpatient rehabilitation in the acute stroke setting have been promising. In a 2011 study, acute stroke patients who received t-PA were found to have significant improvement in their NIHSS [National Institutes of Health Stroke Scale] values and increased likelihood of community discharge without an inpatient rehabilitation stay [3]. For the acute stroke patient who requires inpatient rehabilitation, the impact of intravenous thrombolysis on NIHSS score and eventual community discharge is unknown. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy
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