Discharge disposition to skilled nursing facility after endovascular reperfusion therapy predicts a poor prognosis.
OBJECTIVE
We explore the impact of discharge disposition (independent rehabilitation facility (IRF) vs skilled nursing facility (SNF)) on 90 day outcomes in persons with stroke who received acute endovascular treatment.


METHODS
Using a database from a single primary care stroke center, discharge disposition, National Institutes of Health Stroke Scale (NIHSS), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-Arterial Therapy 2 (HIAT-2), and Acute Physiology and Chronic Health Evaluation (APACHE II) scores, and successful reperfusion were obtained. Univariate analysis was performed to assess predictors of good clinical outcome, as defined by 90 day modified Rankin Scale (mRS) scores ≤2. A binary logistic regression model was used to determine the impact of placement to an IRF versus an SNF on clinical outcomes.


RESULTS
147 subjects were included in the analysis with a mean age of 63±14 years and median NIHSS of 18 (IQR 14-21). Final infarct volumes, and modified APACHE II, THRIVE, and HIAT-2 scores were similar between those discharged to an IRF and those discharged to an SNF.However, their 90 day outcomes were significantly different, with far fewer patients at SNFs achieving good clinical outcomes (25% vs 46%; p=0.023). Disposition to SNF was significantly associated with a lower probability of achieving an mRS score of 0-2 at 90 days (OR = 0.337 (95% CI 0.12 to 0.94); p<0.04).


CONCLUSIONS
Subjects discharged to SNFs and IRFs after thrombectomy have similar medical and neurological severity at admission and similar final infarct volumes at discharge. Despite these similarities, patients discharged to an SNF had a significantly lower probability of achieving a good neurological outcome. These results have implications for future acute stroke trial design.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Samir R
SR
Belagaje
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Chung-Huan J
CH
Sun
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Raul G
RG
Nogueira
Wellstar Neurosurgery, Wellstar Health Systems, Marietta, Georgia, USA.
Brenda A
BA
Glenn
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Lisa Ann
LA
Wuermser
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Vishal
V
Patel
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Michael R
MR
Frankel
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Aaron M
AM
Anderson
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Tommy T
TT
Thomas
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
Christopher M
CM
Horn
Wellstar Neurosurgery, Wellstar Health Systems, Marietta, Georgia, USA.
Rishi
R
Gupta
D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards / Q000639:trends*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000592:standards / Q000639:trends*; D015424:Reperfusion / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000592:standards / Q000639:trends*; D016896:Treatment Outcome
Stroke; Thrombectomy