Stroke severity is predominant predictor of discharge destination for patients

July 19, 2004

CHICAGO - Increasing stroke severity, as measured by the National Institutes of Health Stroke Scale, increases the likelihood that stroke patients who are treated with a clot-dissolving drug will be discharged to rehabilitation or nursing homes, rather than to their own homes, according to an article in the July issue of The Archives of Neurology, one of the JAMA/Archives journals.

A stroke is the sudden death of some brain cells due to a lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. According to information in the article, early determination of discharge destination after acute stroke may promote earlier rehabilitation and reduce costs by shortening the duration of hospitalization. The National Institutes of Health Stroke Scale (NIHSS) is a widely used quantitative measure of stroke-related neurological deficit that includes items to assess level of consciousness, gaze, visual fields, facial palsy, motor strength, ataxia (wobbliness), sensation, language, dysarthria (slurred speech), and extinction or inattention.

Daniel J. Schlegel, M.D., of the University of Pennsylvania Medical Center, Philadelphia, and colleagues conducted a study to determine whether the NIHSS score predicts disposition in stroke patients treated with thrombolysis (administration of medication to dissolve a clot). The study included 546 patients from three countries with acute ischemic stroke, who were treated with recombinant tissue plasminogen activator (rt-PA), a powerful "clot-buster" that is infused through the vein. Medical records were reviewed for demographic information, vascular risk factors, location of stroke, initial NIHSS score, acute hospital disposition, and complications of symptomatic or asymptomatic intracerebral hemorrhage (ICH; bleeding within the brain tissue).

Of the 546 patients included in the study, 44 percent were discharged to home, 42 percent to rehabilitation, and 14 percent to a nursing facility.

"This study demonstrates that stroke severity, as measured by the NIHSS, is the predominant predictor of discharge destination after initial hospitalization for patients with acute ischemic stroke treated with intravenous rt-PA," the authors report.

Analysis showed that increasing NIHSS score was a robust and independent predictor of discharge to rehabilitation or nursing facilities, roughly doubling for each five-point increment.

The authors also found that symptomatic ICH was a devastating complication. "Patients who developed symptomatic ICH were never discharged to home," they write. But asymptomatic ICH had no significant independent effect on disposition.

"This multinational community and academic center-based study reinforces the usefulness of the NIHSS score as a predictor of disposition after stroke," the authors write. "The NIHSS score can predict discharge disposition when thrombolysis is used, although possibly with less precision than in patients not given this treatment."

The authors suggest that future studies should search for other variables rapidly available at admission like the NIHSS score, that could improve prediction of disposition after acute care.

"In addition, simulations or decision analyses could be performed to assess whether cost savings may be realized by using the NIHSS score to initiate early planning for disposition immediately on admission," they conclude.

(Arch Neurol. 2004;61:1061-1064. Available post-embargo at archneurol.com)
-end-
Editor's Note: This study was supported by grants from the National Institutes of Health, Bethesda, Md.; the Canadian Institutes of Health Research, Ottawa, Ontario; and the Alberta Heritage Foundation for Medical Research, Edmonton.

To contact corresponding author Scott E. Kasner, M.D., call Karen Kreeger at 215-662-2560.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

The JAMA Network Journals

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.