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Original research
Discharge disposition to skilled nursing facility after endovascular reperfusion therapy predicts a poor prognosis
  1. Samir R Belagaje1,2,
  2. Chung-Huan J Sun1,
  3. Raul G Nogueira1,2,
  4. Brenda A Glenn3,
  5. Lisa Ann Wuermser4,
  6. Vishal Patel1,2,
  7. Michael R Frankel1,2,
  8. Aaron M Anderson1,2,
  9. Tommy T Thomas1,2,
  10. Christopher M Horn1,2,
  11. Rishi Gupta3
  1. 1Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
  3. 3Wellstar Neurosurgery, Wellstar Health Systems, Marietta, Georgia, USA
  4. 4Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr R Gupta, Wellstar Neurosurgery, Wellstar Health Systems, 61 Whitcher Street, Suite 3110, Marietta, GA 30060, USA; rishi.gupta{at}wellstar.org

Abstract

Objective We explore the impact of discharge disposition (independent rehabilitation facility (IRF) vs skilled nursing facility (SNF)) on 90 day outcomes in persons with stroke who received acute endovascular treatment.

Methods Using a database from a single primary care stroke center, discharge disposition, National Institutes of Health Stroke Scale (NIHSS), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-Arterial Therapy 2 (HIAT-2), and Acute Physiology and Chronic Health Evaluation (APACHE II) scores, and successful reperfusion were obtained. Univariate analysis was performed to assess predictors of good clinical outcome, as defined by 90 day modified Rankin Scale (mRS) scores ≤2. A binary logistic regression model was used to determine the impact of placement to an IRF versus an SNF on clinical outcomes.

Results 147 subjects were included in the analysis with a mean age of63±14 years and median NIHSS of 18 (IQR 14–21). Final infarct volumes, and modified APACHE II, THRIVE, and HIAT-2 scores were similar between those discharged to an IRF and those discharged to an SNF.However, their 90 day outcomes were significantly different, with far fewer patients at SNFs achieving good clinical outcomes (25% vs 46%; p=0.023). Disposition to SNF was significantly associated with a lower probability of achieving an mRS score of 0–2 at 90 days (OR = 0.337 (95% CI 0.12 to 0.94); p<0.04).

Conclusions Subjects discharged to SNFs and IRFs after thrombectomy have similar medical and neurological severity at admission and similar final infarct volumes at discharge. Despite these similarities, patients discharged to an SNF had a significantly lower probability of achieving a good neurological outcome. These results have implications for future acute stroke trial design.

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