Optimizing discharge planning: clinical predictors of longer stay after recombinant tissue plasminogen activator for acute stroke.
OBJECTIVE
The length of stay (LOS) is the main cost-determining factor for inpatients with acute stroke. Although studies have identified variables associated with LOS, few have analyzed predictors of longer stay after receiving thrombolytic therapy for acute stroke.


METHODS
We studied all consecutive acute stroke patients receiving intravenous recombinant tissue plasminogen activator (rtPA) admitted to the London Health Sciences Center, in London, Ontario, Canada, from 1999 to 2003. Longer stay was defined as LOS > or =7 days after admission. Demographic as well as baseline clinical, laboratory, and imaging variables were analyzed to identify predictors of LOS. Significant variables were entered into a multivariate logistic regression analysis.


RESULTS
Among 216 acute stroke patients receiving rtPA, the median LOS was 6 days. LOS was >7 days in 102 (49%) patients. Age > or =70 (odds ratio [OR], 2.2; 95% CI, 1.2 to 4.0), lack of improvement at 24 hours (OR, 2.5; 95% CI, 1.4 to 4.4), prestroke modified Rankin Scale > or =2 (OR, 2.4; 95% CI, 1.2 to 4.9), baseline National Institutes of Health Stroke Scale score > or =15 (OR, 9.4; 95% CI, 3.2 to 27.6), cortical involvement (OR, 2.2; 95% CI, 1.2 to 3.9), and new infarction on the control computed tomography (CT; OR, 2.8; 95% CI, 1.4 to 5.9) were independent predictors of longer stay.


CONCLUSIONS
Lack of improvement at 24 hours after rtPA, cortical involvement, and new infarction on the 24-hour CT scan are relevant variables that can independently affect the LOS. These new variables may be useful for establishing policy in relation to the organization and planning of the health care system.
Saposnik
Gustavo
G
Stroke Program, Department of Clinical Neurological Sciences and Southwestern Ontario Coordinated Stroke Strategy, London Health Science Center, The University of Western Ontario, London, Ontario, Canada. gsaposni@uwo.ca
Webster
Fiona
F
O'Callaghan
Chris
C
Hachinski
Vladimir
V
D000208:Acute Disease; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000235:genetics / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator