Background

The endovascular treatment (ET) for acute ischemic stroke (AIS) is increasing among eligible patients. To help address care quality, administrative data sets are utilized but do not usually include formal outcome scales. We explore the predictive ability of discharge destination from acute hospitalizations for long-term disability among AIS patients eligible for ET within a clinical trial.

Methods

We analyzed publicly available data from the DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) trial. We evaluated patients who survived beyond the time of discharge from their acute hospitalizations. We calculated positive and negative predictive values and accompanying likelihood ratios for patients discharged to home, inpatient rehabilitation facility (IRF), or subacute nursing facility (SNF) for unfavorable outcome as defined by modified Rankin Scale (mRS) scores ≥3 at 90-days.

Results

Our final analysis included 127 patients (median age 67 [23–89] years, 51.2% men). There were 23.6% patients discharged home, 53.5% to IRF, and 22.8% to SNF. Approximately 61% of patients had 90-day post-stroke mRS scores ≥3. Patients discharged to SNF had the highest positive predictive value (93.1%) and positive likelihood ratio (8.77 [CI 95% 2.18–35.25]) for unfavorable outcome. Discharge to home had the highest negative likelihood ratio (2.09 [CI 95% 1.54–2.83]) for unfavorable outcome.

Conclusions

Among AIS patients eligible for ET within the DEFUSE 3 trial, discharge destination can provide high predictive value of 90-day functional outcomes. A discharge to SNF is highly predictive of long-term unfavorable outcomes.

中文翻译：

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符合血管内治疗条件的缺血性卒中患者90天出院终点的预测价值：DEFUSE 3事后分析。

背景

在符合条件的患者中，针对急性缺血性中风（AIS）的血管内治疗（ET）正在增加。为了帮助提高护理质量，使用了行政数据集，但通常不包括正式的结果量表。我们探讨了在临床试验中有资格获得ET的AIS患者中长期住院的急性残疾出院目的地的预测能力。

方法

我们分析了DEFUSE 3（缺血性卒中影像学评估后的血管内治疗）试验的公开数据。我们评估了在急性住院后出院后仍存活的患者。我们根据90天修正后的兰金量表（mRS）评分≥3定义的出院结果，计算了出院，住院康复设施（IRF）或亚急性护理设施（SNF）的患者的阳性和阴性预测值以及伴随的似然比。

结果

我们的最终分析包括127例患者（中位年龄67 [23-89]岁，男性51.2％）。有23.6％的患者出院，IRF的53.5％，SNF的22.8％。大约61％的患者中风后90天的mRS得分≥3。出院SNF患者的不良预后具有最高的阳性预测值（93.1％）和阳性似然比（8.77 [CI 95％2.18–35.25]）。出院对不良结局的负面可能性最高（2.09 [CI 95％1.54–2.83]）。

结论

在DEFUSE 3试验中符合ET资格的AIS患者中，出院目的地可以提供90天功能预后的高预测价值。SNF的排出高度预示了长期不良结果。