Prediction of hospital disposition after thrombolysis for acute ischemic stroke using the National Institutes of Health Stroke Scale.
BACKGROUND
Early determination of discharge destination after acute stroke may promote earlier rehabilitation and reduce costs by shortening the duration of hospitalization.


OBJECTIVE
To determine whether the National Institutes of Health Stroke Scale (NIHSS) score predicts disposition in stroke patients treated with thrombolysis.


METHODS
Cohort study.


METHODS
Academic and community hospitals from 3 countries.


METHODS
Five hundred forty-six patients with acute ischemic stroke treated with recombinant tissue plasminogen activator (rt-PA).


METHODS
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).


METHODS
Discharge destination to home, acute rehabilitation, or nursing facility.


RESULTS
In multinomial regression analysis, increasing NIHSS score was a robust and independent predictor of discharge to rehabilitation or nursing facilities, roughly doubling for each 5-point increment. Patients who developed symptomatic ICH were never discharged to home, but asymptomatic ICH had no significant independent effect on disposition.


CONCLUSIONS
Stroke severity as determined by the admission NIHSS score is the major independent predictor of disposition after hospitalization and treatment with rt-PA for acute stroke in a broad-based population. However, symptomatic ICH after rt-PA is a catastrophic event that may preclude discharge to home.
Schlegel
Daniel J
DJ
Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce Street, 3W Gates Building, Philadelphia, PA 19104, USA.
Tanne
David
D
Demchuk
Andrew M
AM
Levine
Steven R
SR
Kasner
Scott E
SE
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.) / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*; D000071939:Stroke Rehabilitation; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States