Utility of the NIH stroke scale as a predictor of hospital disposition

Daniel Schlegel, Stephen J. Kolb, Jean M. Luciano, Jennifer M. Tovar, Brett L. Cucchiara, David S. Liebeskind, Scott E. Kasner

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

Background and Purpose - Early identification of stroke patients in need of rehabilitation or long-term nursing facility (NF) care may promote more efficient use of health care resources and lead to better outcomes. The NIH Stroke Scale (NIHSS) is an attractive candidate predictor of disposition because it is widely used, is easily learned, and can be performed rapidly on admission. Methods - We present a retrospective study of stroke patients admitted within 24 hours of symptom onset to a university hospital from March through June 2000. Medical records were reviewed for demographic information, stroke type, prestroke living arrangement and independence, initial NIHSS, and medical complications during hospitalization. Results - Among 94 patients evaluated during the study period, 59% were discharged home, 30% to rehabilitation, and 11% to NF. In multivariate analyses, disposition was associated only with initial NIHSS. For each 1-point increase in NIHSS, the likelihood of going home was significantly reduced (odds ratio, 0.79; 95% CI, 0.70 to 0.89, P<0.001). Categorization of NIHSS was also predictive of disposition, with NIHSS ≤5 being most strongly associated with discharge home, NIHSS 6 to 13 with rehabilitation, and NIHSS > 13 with NF (P<0.001). Although no other baseline characteristics predicted disposition, major medical complications during hospitalization tended to reduce the odds of going home (odds ratio, 0.30; 95% CI, 0.08 to 1.0, P=0.07). Conclusion - The NIHSS predicts postacute care disposition among stroke patients. Predicting disposition on the first day of admission may facilitate the time-consuming and costly process of securing a bed at rehabilitation or NF, and perhaps decrease unnecessary length of stay in acute care settings.

Original languageEnglish (US)
Pages (from-to)134-137
Number of pages4
JournalStroke
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2003

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Stroke
Subacute Care
Hospitalization
Nursing
Rehabilitation
Rehabilitation Nursing
Odds Ratio
Health Resources
Nursing Care
Medical Records
Length of Stay
Multivariate Analysis
Retrospective Studies
Demography
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Schlegel, D., Kolb, S. J., Luciano, J. M., Tovar, J. M., Cucchiara, B. L., Liebeskind, D. S., & Kasner, S. E. (2003). Utility of the NIH stroke scale as a predictor of hospital disposition. Stroke, 34(1), 134-137. https://doi.org/10.1161/01.STR.0000048217.44714.02
Schlegel, Daniel ; Kolb, Stephen J. ; Luciano, Jean M. ; Tovar, Jennifer M. ; Cucchiara, Brett L. ; Liebeskind, David S. ; Kasner, Scott E. / Utility of the NIH stroke scale as a predictor of hospital disposition. In: Stroke. 2003 ; Vol. 34, No. 1. pp. 134-137.
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Schlegel, D, Kolb, SJ, Luciano, JM, Tovar, JM, Cucchiara, BL, Liebeskind, DS & Kasner, SE 2003, 'Utility of the NIH stroke scale as a predictor of hospital disposition', Stroke, vol. 34, no. 1, pp. 134-137. https://doi.org/10.1161/01.STR.0000048217.44714.02

Utility of the NIH stroke scale as a predictor of hospital disposition. / Schlegel, Daniel; Kolb, Stephen J.; Luciano, Jean M.; Tovar, Jennifer M.; Cucchiara, Brett L.; Liebeskind, David S.; Kasner, Scott E.

In: Stroke, Vol. 34, No. 1, 01.01.2003, p. 134-137.

Research output: Contribution to journalArticle

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AU - Schlegel, Daniel

AU - Kolb, Stephen J.

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AU - Liebeskind, David S.

AU - Kasner, Scott E.

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N2 - Background and Purpose - Early identification of stroke patients in need of rehabilitation or long-term nursing facility (NF) care may promote more efficient use of health care resources and lead to better outcomes. The NIH Stroke Scale (NIHSS) is an attractive candidate predictor of disposition because it is widely used, is easily learned, and can be performed rapidly on admission. Methods - We present a retrospective study of stroke patients admitted within 24 hours of symptom onset to a university hospital from March through June 2000. Medical records were reviewed for demographic information, stroke type, prestroke living arrangement and independence, initial NIHSS, and medical complications during hospitalization. Results - Among 94 patients evaluated during the study period, 59% were discharged home, 30% to rehabilitation, and 11% to NF. In multivariate analyses, disposition was associated only with initial NIHSS. For each 1-point increase in NIHSS, the likelihood of going home was significantly reduced (odds ratio, 0.79; 95% CI, 0.70 to 0.89, P<0.001). Categorization of NIHSS was also predictive of disposition, with NIHSS ≤5 being most strongly associated with discharge home, NIHSS 6 to 13 with rehabilitation, and NIHSS > 13 with NF (P<0.001). Although no other baseline characteristics predicted disposition, major medical complications during hospitalization tended to reduce the odds of going home (odds ratio, 0.30; 95% CI, 0.08 to 1.0, P=0.07). Conclusion - The NIHSS predicts postacute care disposition among stroke patients. Predicting disposition on the first day of admission may facilitate the time-consuming and costly process of securing a bed at rehabilitation or NF, and perhaps decrease unnecessary length of stay in acute care settings.

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Schlegel D, Kolb SJ, Luciano JM, Tovar JM, Cucchiara BL, Liebeskind DS et al. Utility of the NIH stroke scale as a predictor of hospital disposition. Stroke. 2003 Jan 1;34(1):134-137. https://doi.org/10.1161/01.STR.0000048217.44714.02