Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3- and 12-Months Poststroke Among Stroke Survivors

Abstract Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MFK. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. Objective To determine the predictive value of discharge destination as a surrogate for definin...

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Veröffentlicht in:Archives of physical medicine and rehabilitation 2012-08, Vol.93 (8), p.1408-1413.e1
Hauptverfasser: Qureshi, Adnan I., MD, Chaudhry, Saqib A., MD, Sapkota, Biggya L., MD, Rodriguez, Gustavo J., MD, Suri, M. Fareed K., MD
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container_end_page 1413.e1
container_issue 8
container_start_page 1408
container_title Archives of physical medicine and rehabilitation
container_volume 93
creator Qureshi, Adnan I., MD
Chaudhry, Saqib A., MD
Sapkota, Biggya L., MD
Rodriguez, Gustavo J., MD
Suri, M. Fareed K., MD
description Abstract Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MFK. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. 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 Outcome Measures 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.
doi_str_mv 10.1016/j.apmr.2012.02.032
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Fareed K., MD</creator><creatorcontrib>Qureshi, Adnan I., MD ; Chaudhry, Saqib A., MD ; Sapkota, Biggya L., MD ; Rodriguez, Gustavo J., MD ; Suri, M. Fareed K., MD</creatorcontrib><description>Abstract Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MFK. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. 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 Outcome Measures 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.</description><identifier>ISSN: 0003-9993</identifier><identifier>EISSN: 1532-821X</identifier><identifier>DOI: 10.1016/j.apmr.2012.02.032</identifier><identifier>PMID: 22446290</identifier><identifier>CODEN: APMHAI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Biological and medical sciences ; Comorbidity ; Diseases of the osteoarticular system ; Female ; Humans ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Neurology ; Nursing homes ; Outcome Assessment (Health Care) - methods ; Patient discharge ; Patient Discharge - statistics &amp; numerical data ; Physical Medicine and Rehabilitation ; Predictive Value of Tests ; Prospective Studies ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Randomized Controlled Trials as Topic ; Rehabilitation ; Sex Factors ; Stroke ; Stroke Rehabilitation ; Time Factors ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Archives of physical medicine and rehabilitation, 2012-08, Vol.93 (8), p.1408-1413.e1</ispartof><rights>American Congress of Rehabilitation Medicine</rights><rights>2012 American Congress of Rehabilitation Medicine</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. 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Fareed K., MD</creatorcontrib><title>Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3- and 12-Months Poststroke Among Stroke Survivors</title><title>Archives of physical medicine and rehabilitation</title><addtitle>Arch Phys Med Rehabil</addtitle><description>Abstract Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MFK. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. 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 Outcome Measures 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.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Comorbidity</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Neurology</subject><subject>Nursing homes</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Patient discharge</subject><subject>Patient Discharge - statistics &amp; numerical data</subject><subject>Physical Medicine and Rehabilitation</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rehabilitation</subject><subject>Sex Factors</subject><subject>Stroke</subject><subject>Stroke Rehabilitation</subject><subject>Time Factors</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0003-9993</issn><issn>1532-821X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UtuKFDEQbURxx9Uf8EHyIvjSYy7d2W6QhWXXG-yy4ij4FjLpykxmupMxSQ_sB_jfVjPjenkQioRKzjlV1KmieM7onFEmX2_mejfEOaeMzymG4A-KGasFLxvOvj0sZpRSUbZtK06KJyltMJW1YI-LE86rSvKWzoofVy6ZtY4rIFeQsvM6u-CJTkSTxRhjWOkMxIZIbkLnrIOOfNZ-6zxZGN1PJOs8Pt6O2YQBkJaJKIn2HWG8vAk-rxP5FFJOOYYtkIsh-BVZHBIssHf7ENPT4pHVfYJnx_u0-Pru7ZfLD-X17fuPlxfXpZFU5rI1VSOYppY2gtpaWklFdVYbyTvgYGUD1VJDy5gxnV1a21reGQaNqdulxUOcFucH3d24HKAz4HPUvdpFN-h4p4J26u8f79ZqFfaqlq2UQqDAq6NADN9HHJgacH7Q99pDGJNiVFBRszNRI5QfoCaGlCLY-zKMqsk_tVGTf2ryT1EMwZH04s8G7ym_DEPAyyNAJzTARu2NS79xEtWqZsK9OeAAx7l3EFUyDryBzkUwWXXB_b-P83_opnfeYcUt3EHahDF6NEoxlZCgFtOmTYvGOKWswR38Ce_g0H8</recordid><startdate>20120801</startdate><enddate>20120801</enddate><creator>Qureshi, Adnan I., MD</creator><creator>Chaudhry, Saqib A., MD</creator><creator>Sapkota, Biggya L., MD</creator><creator>Rodriguez, Gustavo J., MD</creator><creator>Suri, M. Fareed K., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120801</creationdate><title>Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3- and 12-Months Poststroke Among Stroke Survivors</title><author>Qureshi, Adnan I., MD ; Chaudhry, Saqib A., MD ; Sapkota, Biggya L., MD ; Rodriguez, Gustavo J., MD ; Suri, M. Fareed K., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c606t-9c4831a0f0830f56f603475c62de2ef68e4bae911ccdfbff9f2dc1e8c59bfc593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Comorbidity</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Neurology</topic><topic>Nursing homes</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Patient discharge</topic><topic>Patient Discharge - statistics &amp; numerical data</topic><topic>Physical Medicine and Rehabilitation</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rehabilitation</topic><topic>Sex Factors</topic><topic>Stroke</topic><topic>Stroke Rehabilitation</topic><topic>Time Factors</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qureshi, Adnan I., MD</creatorcontrib><creatorcontrib>Chaudhry, Saqib A., MD</creatorcontrib><creatorcontrib>Sapkota, Biggya L., MD</creatorcontrib><creatorcontrib>Rodriguez, Gustavo J., MD</creatorcontrib><creatorcontrib>Suri, M. Fareed K., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of physical medicine and rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qureshi, Adnan I., MD</au><au>Chaudhry, Saqib A., MD</au><au>Sapkota, Biggya L., MD</au><au>Rodriguez, Gustavo J., MD</au><au>Suri, M. Fareed K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3- and 12-Months Poststroke Among Stroke Survivors</atitle><jtitle>Archives of physical medicine and rehabilitation</jtitle><addtitle>Arch Phys Med Rehabil</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>93</volume><issue>8</issue><spage>1408</spage><epage>1413.e1</epage><pages>1408-1413.e1</pages><issn>0003-9993</issn><eissn>1532-821X</eissn><coden>APMHAI</coden><abstract>Abstract Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MFK. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. 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 Outcome Measures 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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22446290</pmid><doi>10.1016/j.apmr.2012.02.032</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via ScienceDirect (Elsevier)
subjects Age Factors
Aged
Biological and medical sciences
Comorbidity
Diseases of the osteoarticular system
Female
Humans
Male
Medical sciences
Middle Aged
Miscellaneous
Neurology
Nursing homes
Outcome Assessment (Health Care) - methods
Patient discharge
Patient Discharge - statistics & numerical data
Physical Medicine and Rehabilitation
Predictive Value of Tests
Prospective Studies
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Randomized Controlled Trials as Topic
Rehabilitation
Sex Factors
Stroke
Stroke Rehabilitation
Time Factors
Vascular diseases and vascular malformations of the nervous system
title Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3- and 12-Months Poststroke Among Stroke Survivors
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