Journal
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
Volume 24, Issue 6, Pages 1179-1186Publisher
ELSEVIER
DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.010
Keywords
Discharge disposition; nursing home; risk score; stroke
Categories
Funding
- NRPB Stroke Clinical Trial Consortium [MOST103-2325-B-039-006]
- Academia Sinica Taiwan Biobank Stroke Biosignature Project [BM104010092]
- Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence [MOHW104-TDU-B-212-113002]
- China Medical University Hospital [1MS1]
- Tseng-Lien Lin Foundation, Taichung, Taiwan
- Taiwan Brain Disease Foundation, Taipei, Taiwan
- Katsuzo Memorial Fund, Japan
- Kiyo Aoshima Memorial Fund, Japan
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Background: Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. Methods: We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. Results: Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). Conclusions: The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.
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