1. Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward
- Author
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Thomas M. Hughes, Archy de Berker, Henry de Berker, Hamsaraj Shetty, Salman Mohammed, Htin Aung, and Pedro Duarte
- Subjects
medicine.medical_specialty ,Stroke severity ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Modified Rankin Scale ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Stroke ,Original Research ,Acute stroke ,Inpatient care ,Stroke scale ,business.industry ,Stroke Rehabilitation ,General Medicine ,medicine.disease ,Hospitals ,Patient Discharge ,Community hospital ,Emergency medicine ,business - Abstract
Background and rationale Reliable prediction of discharge destination in acute stroke informs discharge planning and can determine the expectations of patients and carers. There is no existing model that does this using routinely collected indices of pre-morbid disability and stroke severity. Methods Age, gender, pre-morbid modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) were gathered prospectively on an acute stroke unit from 1,142 consecutive patients. A multiclass random forest classifier was used to train and validate a model to predict discharge destination. Results Used alone, the mRS is the strongest predictor of discharge destination. The NIHSS is only predictive when combined with our other variables. The accuracy of the final model was 70.4% overall with a positive predictive value (PPV) and sensitivity of 0.88 and 0.78 for home as the destination, 0.68 and 0.88 for continued inpatient care, 0.7 and 0.53 for community hospital, and 0.5 and 0.18 for death, respectively. Conclusion Pre-stroke disability rather than stroke severity is the strongest predictor of discharge destination, but in combination with other routinely collected data, both can be used as an adjunct by the multidisciplinary team to predict discharge destination in patients with acute stroke.
- Published
- 2021