title: Predictors of 30-day readmission after intracerebral hemorrhage: a single-center approach for identifying potentially modifiable associations with readmission.
abstract: OBJECTIVE
  To determine whether patient's demographics or severity of illness predict hospital readmission within 30 days following spontaneous intracerebral hemorrhage, to identify readmission associations that may be modifiable at the single-center level, and to determine the impact of readmission on outcomes.
  
  
  METHODS
  We collected demographic, clinical, and hospital course data for consecutive patients with spontaneous intracerebral hemorrhage enrolled in an observational study. Readmission within 30 days was determined retrospectively by an automated query with manual confirmation. We identified the reason for readmission and tested for associations between readmission and functional outcomes using modified Rankin Scale (a validated functional outcome measure from 0, no symptoms, to 6, death) scores before intracerebral hemorrhage and at 14 days, 28 days, and 3 months after intracerebral hemorrhage.
  
  
  METHODS
  Neurologic ICU of a tertiary care hospital.
  
  
  METHODS
  Critically ill patients with spontaneous intracerebral hemorrhage.
  
  
  METHODS
  Patients received standard critical care management for intracerebral hemorrhage.
  
  
  RESULTS
  Of 246 patients (mean age, 65 yr; 51% female), 193 patients (78%) survived to discharge. Of these, 22 patients (11%) were readmitted at a median of 9 days (interquartile range, 4-15 d). The most common readmission diagnoses were infections after discharge (n = 10) and vascular events (n = 6). Age, history of stroke and hypertension, severity of neurologic deficit at admission, Acute Physiology and Chronic Health Evaluation score, ICU and hospital length of stay, ventilator-free days, days febrile, and surgical procedures were not predictors of readmission. History of coronary artery disease was associated with readmission (p = 0.03). Readmitted patients had similar modified Rankin Scale and severity of neurologic deficit at 14 days but higher (worse) modified Rankin Scale scores at 3 months (median [interquartile range], 5 [3-6] vs 3 [1-4]; p = 0.01).
  
  
  CONCLUSIONS
  Severity of illness and hospital complications were not associated with 30-day readmission. The most common indication for readmission was infection after discharge, and readmission was associated with worse functional outcomes at 3 months. Preventing readmission after intracerebral hemorrhage may depend primarily on optimizing care after discharge and may improve functional outcomes at 3 months.
authors: 1Department of Neurology, Northwestern University-Feinberg School of Medicine, Chicago, IL. 2Department of Anesthesiology, Northwestern University-Feinberg School of Medicine, Chicago, IL. 3Department of Medical Social Sciences, Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors: Eric M
authors: EM
authors: Liotta
authors: Mandeep
authors: M
authors: Singh
authors: Adam R
authors: AR
authors: Kosteva
authors: Jennifer L
authors: JL
authors: Beaumont
authors: James C
authors: JC
authors: Guth
authors: Rebecca M
authors: RM
authors: Bauer
authors: Shyam
authors: S
authors: Prabhakaran
authors: Neil F
authors: NF
authors: Rosenberg
authors: Matthew B
authors: MB
authors: Maas
authors: Andrew M
authors: AM
authors: Naidech
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000628:therapy; D003327:Coronary Disease / Q000150:complications*; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
references: Neurology. 2006 Jan 24;66(2):206-9
references: 16434655
references: Stroke. 2010 Nov;41(11):2525-33
references: 20930150
references: J Neurol Sci. 2011 Aug 15;307(1-2):50-4
references: 21636101
references: Stroke. 2007 Jun;38(6):2001-23
references: 17478736
references: Stroke. 2007 Jun;38(6):1899-904
references: 17510453
references: Cerebrovasc Dis. 2010 Jan;29(2):137-9
references: 19955737
references: Am J Infect Control. 2008 Jun;36(5):309-32
references: 18538699
references: Stroke. 2010 Nov;41(11):2606-11
references: 20947854
references: Stroke. 2009 May;40(5):1903-6
references: 19286597
references: J Am Geriatr Soc. 2008 Jun;56(6):999-1005
references: 18422948
references: Crit Care Med. 2006 May;34(5):1297-310
references: 16540951
references: Stroke. 2007 Mar;38(3):1091-6
references: 17272767
references: Stroke. 2011 Aug;42(8):2276-9
references: 21680905
references: J Am Geriatr Soc. 2007 Mar;55(3):365-73
references: 17341238
references: Stroke. 2002 Sep;33(9):2243-6
references: 12215594
references: Stroke. 2010 Sep;41(9):2108-29
references: 20651276
references: Stroke. 2000 May;31(5):1038-45
references: 10797163
references: Stroke. 2009 Jul;40(7):2398-401
references: 19443791
references: Stroke. 2011 Dec;42(12):3387-91
references: 22033986
references: Cerebrovasc Dis. 2011;32(3):283-8
references: 21893981
references: Stroke. 2005 Apr;36(4):777-81
references: 15718510
references: Neurocrit Care. 2004;1(1):53-60
references: 16174898
references: Stroke. 2007 May;38(5):1655-711
references: 17431204
references: Stroke. 2010 Dec;41(12):2849-54
references: 20947835
references: Stroke. 2005 Dec;36(12):2756-63
references: 16269630
references: N Engl J Med. 2009 Apr 2;360(14):1418-28
references: 19339721
references: Stroke. 2001 Apr;32(4):891-7
references: 11283388
references: Cerebrovasc Dis. 2006;22(1):21-6
references: 16567933