Discharge destination after acute hospitalization strongly predicts three month disability outcome in ischemic stroke

Area of Science:

• Neurology
• Clinical Trials
• Health Services Research

Background:

• Final global disability at three months post-stroke is a key outcome in clinical trials.
• Discharge destination from acute hospitalization is a readily available administrative proxy.

Purpose of the Study:

• To evaluate the predictive value of discharge destination for three-month global disability.
• To assess if discharge destination can serve as a valid outcome measure.

Main Methods:

• Utilized data from the NINDS-TPA trials (N=624 ischemic stroke patients).
• Characterized discharge destination as a four-level ordinal variable.
• Employed correlation coefficients and logistic regression to analyze the relationship with the modified Rankin Scale (mRS).

Main Results:

• Discharge destinations included home (42.1%), rehabilitation (33.0%), skilled nursing facility (9.8%), and in-hospital death (12.4%).
• A strong correlation (r=0.71, P<0.001) was found between discharge destination and 3-month mRS.
• Discharge destination emerged as the strongest independent predictor of 3-month global disability in logistic regression models.

Conclusions:

• Discharge destination is a powerful predictor of three-month global disability outcomes following acute stroke.
• It represents a valid and useful outcome measure for quality improvement initiatives in stroke care.