NO, NO, NO! Predicting discharge destination is fucking useless to survivors. They want recovery. DO THE GODDAMNED RESEARCH THAT DELIVERS RECOVERY. Not this useless crapola.
Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination
Sinikka Tarvonen-Schröder1,2 , Tuuli Niemi1,2,3 and Mari Koivisto1,2,4
1Neurocenter, Turku University Hospital, Turku, Finland. 2 Department of Clinical Neurosciences,
University of Turku, Turku, Finland. 3 Department of Expert Services, Turku University Hospital,
Turku, Finland. 4 Department of Biostatistics, University of Turku, Turku, Finland.
tion has not been studied.
AIM: The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on
admission to rehabilitation.
1Neurocenter, Turku University Hospital, Turku, Finland. 2 Department of Clinical Neurosciences,
University of Turku, Turku, Finland. 3 Department of Expert Services, Turku University Hospital,
Turku, Finland. 4 Department of Biostatistics, University of Turku, Turku, Finland.
ABSTRACT
BACKGROUND: Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilita-tion has not been studied.
AIM: The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on
admission to rehabilitation.
MATERIAL AND METHODS: On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression.
RESULTS: 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those dis-
charged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase,
shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score,
ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized.
CONCLUSION: The most influential independent predictors for community discharge on admission to rehabilitation were lower admission
NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased
with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional dis-
charge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
KEYWORDS: Discharge destination, National Institutes of Health Stroke Scale, predictor, rehabilitation, stroke
ReCeIVeD: December 7, 2022. ACCePTeD: January 25, 2023.
TyPe: Original Research
FuNDINg: The author(s) received no financial support for the research, authorship, and/or
publication of this article.
DeClARATION OF CONFlICTINg INTeReSTS: The author(s) declared no potential
conflicts of interest with respect to the research, authorship, and/or publication of this
article.
CORReSPONDINg AuTHOR: Sinikka Tarvonen-Schröder, Neurocenter, Turku University
Hospital, PO Box 52, Turku, FIN 20521, Finland. Email: sinikka.tarvonen-schroder@tyks.fi.
RESULTS: 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those dis-
charged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase,
shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score,
ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized.
CONCLUSION: The most influential independent predictors for community discharge on admission to rehabilitation were lower admission
NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased
with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional dis-
charge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
KEYWORDS: Discharge destination, National Institutes of Health Stroke Scale, predictor, rehabilitation, stroke
ReCeIVeD: December 7, 2022. ACCePTeD: January 25, 2023.
TyPe: Original Research
FuNDINg: The author(s) received no financial support for the research, authorship, and/or
publication of this article.
DeClARATION OF CONFlICTINg INTeReSTS: The author(s) declared no potential
conflicts of interest with respect to the research, authorship, and/or publication of this
article.
CORReSPONDINg AuTHOR: Sinikka Tarvonen-Schröder, Neurocenter, Turku University
Hospital, PO Box 52, Turku, FIN 20521, Finland. Email: sinikka.tarvonen-schroder@tyks.fi.
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