Stroke rehabilitation: indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes.
OBJECTIVE
The aim of this study was to investigate the associations between tracheostomies, enteral feeding tubes, and indwelling urinary catheters and functional outcome measures, incidence of medical complications, and resource use in an inpatient stroke rehabilitation program.


METHODS
A cohort of 1553 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke characteristics, impairment (National Institutes of Health Stroke Scale) and disability level (Functional Independence Measure [FIM]), preexisting medical conditions, and the presence of tracheostomies, enteral feeding tubes, and indwelling urinary catheters were recorded at admission. The occurrence of medical complications during rehabilitation, discharge disability level, length of rehabilitation stay, and rehabilitation hospital charges were recorded at discharge.


RESULTS
Compared with patients with no medical tubes, patients with 3 medical tubes had significantly higher National Institutes of Health Stroke Scale scores, lower admission and discharge FIM scores, reduced FIM efficiency scores (average FIM score change per day), and twice the number of medical complications. Patients with 3 medical tubes stayed 28 days longer in acute hospitalization and 20 days longer in rehabilitation compared with patients with no medical tubes. The presence of even a single medical tube was associated with longer length of stay, more medical complications during rehabilitation, and greater disability level at discharge.


CONCLUSIONS
The presence of > or =1 medical tubes is associated with more severe and disabling strokes, an increased number of medical complications, longer acute and rehabilitation hospitalizations, and greater resource use.
Roth
Elliot J
EJ
Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Chicago, Ill, USA. ejr@northwestern.edu
Lovell
Linda
L
Harvey
Richard L
RL
Bode
Rita K
RK
Heinemann
Allen W
AW
D000368:Aged; D002408:Catheters, Indwelling / Q000706:statistics & numerical data; D015331:Cohort Studies; D003710:Demography; D004185:Disability Evaluation; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges; D006801:Humans; D007087:Illinois; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000191:economics; D000071939:Stroke Rehabilitation; D014139:Tracheostomy / Q000706:statistics & numerical data*; D014546:Urinary Catheterization / Q000706:statistics & numerical data*