title: Discharge destination after acute hospitalization strongly predicts three month disability outcome in ischemic stroke.
abstract: OBJECTIVE
  Final global disability 3 months post-stroke is the cardinal endpoint in acute stroke clinical trials. The most similar variable available in administrative datasets is discharge destination at end of the acute hospitalization. We investigated the predictive value of discharge destination for final global disability.
  
  
  METHODS
  In the public dataset of the two NINDS-TPA trials, we characterized discharge destination as a 4 level ordinal variable. Correlation coefficients and logistic models probed the relation with the modified Rankin Scale (mRS) of global disability at 3 months.
  
  
  RESULTS
  Among the 624 ischemic stroke patients, discharge destination was home in 42.1% , rehabilitation in 33.0% , skilled nursing facility in 9.8% , and in hospital-death in 12.4% . A strong correlation was noted between hospital discharge destination and 3 month mRS, r = 0.71, P < 0.001. Length of stay showed a weaker correlation with 3 month mRS, r = 0.29, p < 0.0001. A multiple logistic regression model identified 4 categories of independent predictors of 3 month global disability outcome, with discharge destination as the strongest independent variable.
  
  
  CONCLUSIONS
  Discharge destination is a powerful predictor of final 3 month global disability outcomes and a valid outcome measure for use in local and national quality improvement programs.
authors.affiliation: Department of Neurology, Beijing University of Chinese Medicine Subsidiary Dongfang Hospital, Beijing, China.
authors.forename: Qihui
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Mathematical Sciences, Tsinghua University, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Stroke Center and Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles Los Angeles, California, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000628:therapy*; D002986:Clinical Trials as Topic; D066264:Datasets as Topic; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011379:Prognosis; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Hospital discharge destination; Ischemic stroke; Modified rankin score