Association between prestroke disability and inpatient mortality and length of acute hospital stay after acute stroke

Chun S Kwok, Allan Clark, Gary A Ford, Ramesh Durairaj, Anand K Dixit, John Davis, Anil K Sharma, John F Potter, Phyo K Myint

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To examine the prognostic value of prestroke disability in predicting inpatient mortality and length of hospital stay (LOS) independent of age, sex, and stroke type and severity.

DESIGN: Retrospective analysis of prospectively collected stroke registers.

SETTING: United Kingdom.

PARTICIPANTS: Fourteen thousand four hundred thirty-seven individuals (52.9% female, mean age 75.4 ± 12.1) with stroke (82% ischemic) admitted to three university hospitals.

MEASUREMENTS: Data were examined from three hospital registers: Aintree (2005-2010), Newcastle (2000-2005), and Norwich (1997-2010). Risk of inpatient death and prolonged hospital stay according to prestroke disability using the modified Rankin Score (mRs) were assessed using logistic regression adjusting for age, sex, and stroke subtype (ischemic vs hemorrhagic) and severity.

RESULTS: Inpatient death was 20.8%. In fully adjusted models, higher prestroke mRs was associated with significantly greater risk of mortality (for mRs = 1, 2, 3, 4, and 5 vs mRs = 0: odds ratio (OR)=1.28, 95% confidence interval (CI)=1.09-1.50; OR = 1.50, 95% CI = 1.29-1.75; OR = 1.85, 95% CI = 1.60-2.13; OR = 2.56, 95% CI = 2.15-3.04; and OR = 4.48, 95% CI = 3.47-5.80, respectively). The relationship appeared to be linear, and each point increase in mRs equated to being approximately 5 years older. Although age and stroke type appear to be strong independent predictors of LOS, premorbid mRs also predicted longer LOS regardless of discharge status. The predictability of the model using these parameters was very good (receiver operating characteristic: 0.82 for death and 0.65-0.70 for LOS).

CONCLUSION: Prestroke disability predicts inpatient death and LOS, independent of age, sex, and stroke type and severity. Whether this is related to mental or physical disability should be examined in future prospective studies.

Original languageEnglish
Pages (from-to)726-732
Number of pages7
JournalJournal of the American Geriatrics Society
Volume60
Issue number4
Early online date8 Feb 2012
DOIs
Publication statusPublished - Apr 2012

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Inpatients
Length of Stay
Stroke
Mortality
Odds Ratio
Confidence Intervals
ROC Curve
Logistic Models
Prospective Studies

Keywords

  • aged
  • aged, 80 and over
  • disability evaluation
  • disabled persons
  • female
  • Great Britain
  • hospital mortality
  • humans
  • length of stay
  • male
  • middle aged
  • prognosis
  • retrospective studies
  • risk factors
  • stroke

Cite this

Association between prestroke disability and inpatient mortality and length of acute hospital stay after acute stroke. / Kwok, Chun S; Clark, Allan; Ford, Gary A; Durairaj, Ramesh; Dixit, Anand K; Davis, John; Sharma, Anil K; Potter, John F; Myint, Phyo K.

In: Journal of the American Geriatrics Society, Vol. 60, No. 4, 04.2012, p. 726-732.

Research output: Contribution to journalArticle

Kwok, Chun S ; Clark, Allan ; Ford, Gary A ; Durairaj, Ramesh ; Dixit, Anand K ; Davis, John ; Sharma, Anil K ; Potter, John F ; Myint, Phyo K. / Association between prestroke disability and inpatient mortality and length of acute hospital stay after acute stroke. In: Journal of the American Geriatrics Society. 2012 ; Vol. 60, No. 4. pp. 726-732.
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AU - Kwok, Chun S

AU - Clark, Allan

AU - Ford, Gary A

AU - Durairaj, Ramesh

AU - Dixit, Anand K

AU - Davis, John

AU - Sharma, Anil K

AU - Potter, John F

AU - Myint, Phyo K

N1 - © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

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N2 - OBJECTIVES: To examine the prognostic value of prestroke disability in predicting inpatient mortality and length of hospital stay (LOS) independent of age, sex, and stroke type and severity.DESIGN: Retrospective analysis of prospectively collected stroke registers.SETTING: United Kingdom.PARTICIPANTS: Fourteen thousand four hundred thirty-seven individuals (52.9% female, mean age 75.4 ± 12.1) with stroke (82% ischemic) admitted to three university hospitals.MEASUREMENTS: Data were examined from three hospital registers: Aintree (2005-2010), Newcastle (2000-2005), and Norwich (1997-2010). Risk of inpatient death and prolonged hospital stay according to prestroke disability using the modified Rankin Score (mRs) were assessed using logistic regression adjusting for age, sex, and stroke subtype (ischemic vs hemorrhagic) and severity.RESULTS: Inpatient death was 20.8%. In fully adjusted models, higher prestroke mRs was associated with significantly greater risk of mortality (for mRs = 1, 2, 3, 4, and 5 vs mRs = 0: odds ratio (OR)=1.28, 95% confidence interval (CI)=1.09-1.50; OR = 1.50, 95% CI = 1.29-1.75; OR = 1.85, 95% CI = 1.60-2.13; OR = 2.56, 95% CI = 2.15-3.04; and OR = 4.48, 95% CI = 3.47-5.80, respectively). The relationship appeared to be linear, and each point increase in mRs equated to being approximately 5 years older. Although age and stroke type appear to be strong independent predictors of LOS, premorbid mRs also predicted longer LOS regardless of discharge status. The predictability of the model using these parameters was very good (receiver operating characteristic: 0.82 for death and 0.65-0.70 for LOS).CONCLUSION: Prestroke disability predicts inpatient death and LOS, independent of age, sex, and stroke type and severity. Whether this is related to mental or physical disability should be examined in future prospective studies.

AB - OBJECTIVES: To examine the prognostic value of prestroke disability in predicting inpatient mortality and length of hospital stay (LOS) independent of age, sex, and stroke type and severity.DESIGN: Retrospective analysis of prospectively collected stroke registers.SETTING: United Kingdom.PARTICIPANTS: Fourteen thousand four hundred thirty-seven individuals (52.9% female, mean age 75.4 ± 12.1) with stroke (82% ischemic) admitted to three university hospitals.MEASUREMENTS: Data were examined from three hospital registers: Aintree (2005-2010), Newcastle (2000-2005), and Norwich (1997-2010). Risk of inpatient death and prolonged hospital stay according to prestroke disability using the modified Rankin Score (mRs) were assessed using logistic regression adjusting for age, sex, and stroke subtype (ischemic vs hemorrhagic) and severity.RESULTS: Inpatient death was 20.8%. In fully adjusted models, higher prestroke mRs was associated with significantly greater risk of mortality (for mRs = 1, 2, 3, 4, and 5 vs mRs = 0: odds ratio (OR)=1.28, 95% confidence interval (CI)=1.09-1.50; OR = 1.50, 95% CI = 1.29-1.75; OR = 1.85, 95% CI = 1.60-2.13; OR = 2.56, 95% CI = 2.15-3.04; and OR = 4.48, 95% CI = 3.47-5.80, respectively). The relationship appeared to be linear, and each point increase in mRs equated to being approximately 5 years older. Although age and stroke type appear to be strong independent predictors of LOS, premorbid mRs also predicted longer LOS regardless of discharge status. The predictability of the model using these parameters was very good (receiver operating characteristic: 0.82 for death and 0.65-0.70 for LOS).CONCLUSION: Prestroke disability predicts inpatient death and LOS, independent of age, sex, and stroke type and severity. Whether this is related to mental or physical disability should be examined in future prospective studies.

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KW - aged, 80 and over

KW - disability evaluation

KW - disabled persons

KW - female

KW - Great Britain

KW - hospital mortality

KW - humans

KW - length of stay

KW - male

KW - middle aged

KW - prognosis

KW - retrospective studies

KW - risk factors

KW - stroke

U2 - 10.1111/j.1532-5415.2011.03889.x

DO - 10.1111/j.1532-5415.2011.03889.x

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JO - Journal of the American Geriatrics Society

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