Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3-and 12-Months Poststroke Among Stroke Survivors
Discharge Destination as a Surrogate for Modified Rankin Scale Defined Outcomes at 3-and 12-Months Poststroke Among Stroke Survivors
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DOI：
10.1016/j.apmr.2012.02.032
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发表时间：
2012-08-01
影响因子：
4.3
通讯作者：
Suri, M. Fareed K.
中科院分区：
文献类型：
--
作者：
Qureshi, Adnan I.;Chaudhry, Saqib A.;Suri, M. Fareed K.
目的：确定出院目的地作为卒中后3个月和12个月不良结局的替代指标的预测价值。设计：分析前瞻性收集的随机、安慰剂对照试验数据，这些数据来自症状发作3小时内出现的缺血性卒中患者。设置：对临床试验招募的患者进行事后分析。参与者：缺血性卒中后患者（N=530）从医院存活出院。干预措施：不适用。主要结局指标：根据改良兰金量表（MRS）评分2 - 6分、3 - 6分，或4至6。似然比表示与没有不利结果的患者相比，在具有不利结果的患者中看到特定出院目的地的可能性高（或低）多少倍。对于卒中后3个月时MRS评分2 - 6分（95%）和康复机构（89%）定义的不良结局，疗养院和康复机构出院的阳性预测值最高，分别与MRS评分3 - 6（79%）和4 - 6（57%）相比，康复机构/疗养院（90%）对MRS评分2 - 6定义的不良结局的阳性预测值也最高。出院疗养院的阳性似然比最高（13; 95%置信区间[CI]，4.1-41），其次是出院康复机构，其不良结局定义为卒中后3个月MRS评分为2 - 6分（5.3; 95% CI，3.5-7.9）。对于由MRS评分2 - 6定义的不利结局，出院回家的阴性似然比最高（4.5; 95% CI，3.4-6.1）。观察到一个类似的模式与不利的结果定义使用各种阈值在12 months.Conclusions：出院目的地可以提供高的预测值和似然比的死亡和残疾在中风后3个月，定义的MRS评分为2至6。
Objective: To determine the predictive value of discharge destination as a surrogate for defining unfavorable outcome at 3- and 12-months poststroke.Design: Analysis of the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset.Setting: Post hoc analysis of patients recruited in a clinical trial.Participants: Patients (N=530) discharged alive from the hospital after ischemic stroke.Interventions: Not applicable.Main Outcome Measures: Positive and negative predictive value and likelihood ratios of discharge destination for unfavorable outcome at 3- and 12-months poststroke defined by a Modified Rankin Scale (MRS) score of 2 to 6, 3 to 6, or 4 to 6. A likelihood ratio indicates how many times more (or less) likely a particular discharge destination is seen in patients with an unfavorable outcome compared with those without unfavorable outcome.Results: The positive predictive value of nursing home and rehabilitation facility discharges was highest for unfavorable outcome defined by an MRS score of 2 to 6 (95%) and rehabilitation facility (89%) at 3-months poststroke, respectively. The positive predictive value of rehabilitation facility/nursing home (90%) was also highest for unfavorable outcomes defined by an MRS score of 2 to 6 compared with those defined by MRS scores of 3 to 6 (79%) and 4 to 6 (57%). The positive likelihood ratio was highest for nursing home discharges (13; 95% confidence interval [CI], 4.1-41) followed by rehabilitation facility discharges for unfavorable outcome defined by an MRS score of 2 to 6 at 3-months poststroke (5.3; 95% Cl, 3.5-7.9). The negative likelihood ratio was the highest for home discharge for unfavorable outcome defined by an MRS score of 2 to 6 (4.5; 95% Cl, 3.4-6.1). A similar pattern was observed with unfavorable outcome defined using various thresholds at 12 months.Conclusions: Discharge destination can provide high predictive values and likelihood ratios for death and disability at 3-months poststroke, as defined by an MRS of score of 2 to 6.