title: The interaction of aspiration pneumonia with demographic and cerebrovascular disease risk factors is predictive of discharge level of care in acute stroke patient.
abstract: OBJECTIVE
  This study aimed to evaluate factors that help determine the post-acute level of care for stroke patients with aspiration pneumonia (ASPNA).
  
  
  METHODS
  This was a retrospective observational study of patients admitted to the University of Texas at Houston Medical School Stroke Service between July 2004 and October 2009 with discharge dispositions of home, inpatient rehabilitation, skilled nursing facility, or subacute care (n = 3511). Demographics, stroke risk factors, and National Institutes of Health Stroke Scale (NIHSS) values were collected. Interactions were evaluated between ASPNA and aging, ASPNA and NIHSS, ASPNA and use of tube feeding, and ASPNA and history of stroke. Using multivariable logistic regression, the data were analyzed for differences in disposition among patients with ASPNA.
  
  
  RESULTS
  There were significant correlations between ASPNA and an NIHSSvalue of 7.44 or greater for discharge to inpatient rehabilitation, skilled nursing facility, or subacute care compared with discharge to home (P = 0.0138); between ASPNA and an NIHSS value of 10.93 or greater for discharge to skilled nursing facility or subacute care compared with inpatient rehabilitation (P < 0.0001); and between ASPNA and age greater than 69.30 yrs for discharge to subacute care compared with a skilled nursing facility (P G 0.0001).
  
  
  CONCLUSIONS
  Patients with ASPNA and an NIHSS value of 7.44 or greater are more likely to require additional postacute care. ASPNA and an NIHSS value of 10.93 or greater increased the chance of postacute care at a level suggestive of lower functional status (skilled nursing facility or subacute care compared with inpatient rehabilitation). Age greater than 69.30 yrs plus ASPNA increased the likelihood of placement in subacute care vs. a skilled nursing facility.
authors.affiliation: Department of Neurology, University of Texas Medical School at Houston, 77030, USA.
authors.forename: Nneka L
authors.initials: NL
authors.lastname: Ifejika-Jones
authors.forename: Nusrat
authors.initials: N
authors.lastname: arun
authors.forename: Hui
authors.initials: H
authors.lastname: Peng
authors.forename: A
authors.initials: A
authors.lastname: Elizabeth
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Francisco
mesh_terms: D000367:Age Factors; D000368:Aged; D004750:Enteral Nutrition; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011015:Pneumonia, Aspiration / Q000453:epidemiology*; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D020521:Stroke / Q000453:epidemiology*; D019467:Subacute Care