Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors.
Arch Phys Med Rehabil
; 93(8): 1408-1413.e1, 2012 Aug.
Article
en En
| MEDLINE
| ID: mdl-22446290
ABSTRACT
OBJECTIVE:
To determine the predictive value of discharge destination as a surrogate for defining unfavorable outcome at 3- and 12-months poststroke.DESIGN:
Analysis of the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset.SETTING:
Post hoc analysis of patients recruited in a clinical trial.PARTICIPANTS:
Patients (N=530) discharged alive from the hospital after ischemic stroke.INTERVENTIONS:
Not applicable. MAIN OUTCOMEMEASURES:
Positive and negative predictive value and likelihood ratios of discharge destination for unfavorable outcome at 3- and 12-months poststroke defined by a Modified Rankin Scale (MRS) score of 2 to 6, 3 to 6, or 4 to 6. A likelihood ratio indicates how many times more (or less) likely a particular discharge destination is seen in patients with an unfavorable outcome compared with those without unfavorable outcome.RESULTS:
The positive predictive value of nursing home and rehabilitation facility discharges was highest for unfavorable outcome defined by an MRS score of 2 to 6 (95%) and rehabilitation facility (89%) at 3-months poststroke, respectively. The positive predictive value of rehabilitation facility/nursing home (90%) was also highest for unfavorable outcomes defined by an MRS score of 2 to 6 compared with those defined by MRS scores of 3 to 6 (79%) and 4 to 6 (57%). The positive likelihood ratio was highest for nursing home discharges (13; 95% confidence interval [CI], 4.1-41) followed by rehabilitation facility discharges for unfavorable outcome defined by an MRS score of 2 to 6 at 3-months poststroke (5.3; 95% CI, 3.5-7.9). The negative likelihood ratio was the highest for home discharge for unfavorable outcome defined by an MRS score of 2 to 6 (4.5; 95% CI, 3.4-6.1). A similar pattern was observed with unfavorable outcome defined using various thresholds at 12 months.CONCLUSIONS:
Discharge destination can provide high predictive values and likelihood ratios for death and disability at 3-months poststroke, as defined by an MRS of score of 2 to 6.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Alta del Paciente
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Evaluación de Resultado en la Atención de Salud
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Rehabilitación de Accidente Cerebrovascular
Tipo de estudio:
Clinical_trials
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Observational_studies
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Prognostic_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Arch Phys Med Rehabil
Año:
2012
Tipo del documento:
Article
País de afiliación:
Estados Unidos