Article

We investigated factors associated with Care Home (CH) discharge
following stroke using routinely collected data in unselected patients and
assessed the relevance of previous research findings to such patients seen in
routine clinical practice. DESIGN: Retrospective analysis of data from the
Sentinel Stroke National Audit Programme using univariate analysis and logistic
regression. SETTING: A large acute and rehabilitation UK stroke unit with access
to early supported discharge. SUBJECTS: All patients with stroke treated from 1
January 2014 to 1 January 2017. MAIN MEASURES: National Institutes of Health
Stroke Scale (NIHSS) and modified Rankin Scale (mRS). RESULTS: Of 2584 patients
(median age 78 years, interquartile range (IQR) 69-86; 50.6% male; 86.7%
infarcts; median admission NIHSS 4, IQR 2-9), 401 (15.5%) died in hospital and
203 patients (7.9%) were permanently discharged to CH for the first time. Most
had pre-discharge mRS scores of 4/5. Factors (odds ratios; 95% confidence
intervals) associated with CH discharge included age (1.07; 1.05-1.10),
incontinence (11.5; 7.13-19.25), dysphagia (2.13; 1.39-3.29), severe weakness
(1.93; 1.28-2.92), pneumonia (1.68; 1.13-2.50), urinary tract infection (UTI)
(1.70; 1.04-2.75) and depression (1.65; 1.00-2.72). In a subgroup of all patients
with a pre-discharge mRS of 4/5, age (1.04; 1.02-1.06), incontinence (4.87;
2.39-11.02), UTI (2.0; 1.09-3.71) and pneumonia (1.59; 1.02-2.50) were the only
factors associated with CH discharge. CONCLUSION: Potentially modifiable
variables like incontinence, UTI and pneumonia were associated with CH discharge,
particularly in the severely disabled.

Langue : ANGLAIS