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Risks of acute hospital transfer and mortality during stroke rehabilitation
Margaret G Stineman1, Richard Ross, Greg Maislin
1Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
Objective:
To identify demographic, medical, and functional factors associated with transfer of stroke patients to acute hospital services and/or mortality during stroke rehabilitation.
Design:
Two case-control studies in which logistic regression was used to control for clinical traits associated with differences in likelihood.
Setting:
A total of 542 US inpatient and rehabilitation units.
Participants:
A total of 64,471 patients discharged during 1995.
Interventions:
Not applicable.
Main Outcome Measures:
Transfer to an acute hospital service and death.
Results:
There were 5847 (9.1%) acute hospital transfers and 320 (0.5%) deaths. Greater disability at admission was associated with higher odds of both acute hospitalization and mortality. Cardiopulmonary arrest, chest pain, gastrointestinal problems, bleeding disorders, hypercoagulable states, and acute renal difficulties increased the relative odds of acute hospitalization from 3.1 (95% confidence interval [CI], 2.3-4.2) to 12.7 (95% CI, 9.2-17.6). The likelihood of mortality for patients 85 years of age or older was more than 2-fold (2.5; 95% CI, 1.7-3.6) that of patients 65 years of age or younger for blacks, it was nearly 2-fold (1.7; 95% CI, 1.3-2.3) compared with whites, after adjusting for clinical differences.
Conclusion:
Higher likelihoods of mortality among older patients versus younger, black patients versus white, and patients with more rather than less disability at admission suggest the need for greater vigilance in monitoring medical status.