Premium
Association Between Prestroke Disability and Inpatient Mortality and Length of Acute Hospital Stay After Acute Stroke
Author(s) -
Kwok Chun S.,
Clark Allan,
Ford Gary A.,
Durairaj Ramesh,
Dixit Anand K.,
Davis John,
Sharma Anil K.,
Potter John F.,
Myint Phyo K.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03889.x
Subject(s) - medicine , stroke (engine) , confidence interval , odds ratio , logistic regression , retrospective cohort study , physical therapy , pediatrics , mechanical engineering , engineering
Objectives To examine the prognostic value of prestroke disability in predicting inpatient mortality and length of hospital stay ( LOS ) independent of age, sex, and stroke type and severity. Design Retrospective analysis of prospectively collected stroke registers. Setting United Kingdom. Participants Fourteen thousand four hundred thirty‐seven individuals (52.9% female, mean age 75.4 ± 12.1) with stroke (82% ischemic) admitted to three university hospitals. Measurements Data were examined from three hospital registers: Aintree (2005–2010), Newcastle (2000–2005), and Norwich (1997–2010). Risk of inpatient death and prolonged hospital stay according to prestroke disability using the modified Rankin Score ( mR s) were assessed using logistic regression adjusting for age, sex, and stroke subtype (ischemic vs hemorrhagic) and severity. Results Inpatient death was 20.8%. In fully adjusted models, higher prestroke mR s was associated with significantly greater risk of mortality (for mR s = 1, 2, 3, 4, and 5 vs mR s = 0: odds ratio (OR)=1.28, 95% confidence interval (CI)=1.09–1.50; OR = 1.50, 95% CI = 1.29–1.75; OR = 1.85, 95% CI = 1.60–2.13; OR = 2.56, 95% CI = 2.15–3.04; and OR = 4.48, 95% CI = 3.47–5.80, respectively). The relationship appeared to be linear, and each point increase in mR s equated to being approximately 5 years older. Although age and stroke type appear to be strong independent predictors of LOS, premorbid mR s also predicted longer LOS regardless of discharge status. The predictability of the model using these parameters was very good (receiver operating characteristic: 0.82 for death and 0.65–0.70 for LOS). Conclusion Prestroke disability predicts inpatient death and LOS , independent of age, sex, and stroke type and severity. Whether this is related to mental or physical disability should be examined in future prospective studies.