Which Comorbidities and Complications Predict Ischemic Stroke Recovery and Length of Stay?
Which Comorbidities and Complications Predict Ischemic Stroke Recovery and Length of Stay?
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DOI：
10.1097/nrl.0000000000000040
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发表时间：
2015-08-01
期刊：
影响因子：
1.2
通讯作者：
Madhavan, Ramesh
中科院分区：
文献类型：
--
作者：
Mohamed, Wazim;Bhattacharya, Pratik;Madhavan, Ramesh
目标：中风是全球第二大常见死亡原因，可导致严重残疾和长期费用。住院时间 (LOS) 是确定住院费用的最具预测性的因素。在本研究中，对影响城市社区医院和2所大学教学医院收治的缺血性脑卒中患者残疾和LOS的因素进行了评估。方法：通过查阅出院诊断国际疾病分类代码，收集连续的急性缺血性脑卒中患者的数据。使用数据挖掘过程来分析入学数据。通过挖掘各自的国际疾病分类 9 代码的二级诊断来提取有关合并症和并发症的数据。主要结局是 LOS，根据入院日期和出院日期计算。第二个值得关注的结果是残疾，通过出院时改良的Rankin评分进行评估。结果：LOS随着残疾程度的增加而逐渐增加。入院时年龄较大和美国国立卫生研究院卒中量表较高与较高的残疾率和较长的住院时间相关。充血性心力衰竭或慢性肾病、心房颤动、其他心律失常（既往存在或新发）以及急性肾衰竭的发生与较高的 LOS 相关，但与较高的残疾状态无关。既往有中风史的患者以及出现尿路感染并发症的患者的残疾程度较高。结论：入院时年龄较大和美国国立卫生研究院卒中量表较高与较高的残疾程度和较长的 LOS 相关。充血性心力衰竭、CRF、心律失常的存在以及急性肾衰竭的发生与较大的 LOS 相关。尿路感染的发展导致更高的残疾。
Objectives: Stroke is the second most common cause of death worldwide and can lead to significant disability and long-term costs. Length of stay (LOS) is the most predictive factor in determining inpatient costs. In the present study, factors that affect disability and LOS among ischemic stroke patients admitted to an urban community hospital and 2 university-based teaching hospitals were assessed.Methods: Data for consecutive patients with acute ischemic strokes were collected, by reviewing discharge diagnosis International Classification of Diseases codes. A data mining process was used to analyze admission data. Data regarding comorbidities and complications were abstracted by mining the secondary diagnoses for their respective International Classification of Diseases-9 codes. The primary outcome was LOS, calculated from the dates of admission and dates of discharge. The second outcome of interest was disability, which was evaluated by the modified Rankin score at the time of discharge.Results: LOS progressively increased with greater disability. Greater age and higher National Institute of Health Stroke Scale at admission were associated with both higher disability and longer LOS. Presence of congestive heart failure or chronic kidney disease, atrial fibrillation, other arrhythmias (preexisting or new onset), and development of acute renal failure were associated with greater LOS but not greater disability status. Patients with a previous stroke and those that developed urinary tract infection as a complication had higher disability.Conclusions: Greater age and higher National Institute of Health Stroke Scale at admission were associated with both higher disability and longer LOS. Congestive heart failure, CRF, presence of arrhythmias, and development of acute renal failure were associated with greater LOS. The development of urinary tract infection caused higher disability.