Poster 197: Hypotension in poststroke patients: effects on outcome.

Abstract

Objectives: To evaluate (1) the incidence of orthostatic hypotension and hypotension without documented orthostatic blood pressures in poststroke patients who participate in inpatient rehabilitation, and (2) whether hypotension increases length of stay (LOS) or FIM™ instrument changes compare with stroke patients who do not have hypotension. Design: Retrospective study. Setting: Veterans Affairs inpatient rehabilitation ward. Participants: 75 subjects (74 men, 1 women) with first-time acute cerebrovascular accident admitted to rehabilitation floor. Interventions: Not applicable. Main Outcome Measures: Acute and rehabilitation LOS, admission and discharge FIM scores, FIM change, and FIM efficiency (FIM change/rehabilitation LOS). Results: 25 subjects had hypotension, 7 of 25 subjects had orthostatic hypotension, and 18 of 25 had hypotension (at least >20mmHg decrease in blood pressure from the baseline with or without dizziness) without documented orthostatic blood pressures. 50 subjects had no hypotension. Hypotension subjects had a mean age of 72.0±10.7 years compared with the nonhypotensive subjects, who had a mean age of 66.8±12.0 years ( P<.05). Hypotensive subjects had a rehabilitation LOS of 29.0±11.8 days compared with nonhypotensive subjects at 21.6±10.2 days ( P<.01). Hypotensive subjects had a FIM efficiency score of .94±.47 compared with nonhypotensive subjects at 1.2±0.5 ( P<.05). There was no significant correlation between rehabilitation LOS and age. No significant differences were found in acute LOS, admission FIM scores, discharge FIM scores, or FIM change ( P<.05). Conclusions: There is a high prevalence (33%) of hypotension in our study patients who were admitted to the rehabilitation floor. Hypotension adversely effected the LOS and FIM efficency. Hypotension needs to be aggressively taken into consideration by the rehabilitation team early to improve the efficiency of care.