Return to primary service among bone marrow transplant rehabilitation inpatients: an index for predicting outcomes.

OBJECTIVE

To assess rehabilitation inpatient risk of return to primary (RTP) service in patients with bone marrow transplant (BMT).

DESIGN

Retrospective review.

SETTING

Inpatient rehabilitation unit within a tertiary referral-based cancer center.

PARTICIPANTS

All patients with BMT (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We analyzed RTP service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values.

RESULTS

A total of 61 (41%) of 147 of BMT admissions were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 23 (38%) of 61 died after being transferred back to the primary service. Significant or near-significant relationships were found for a platelet count of <43,000 per microliter (P<.01); a creatinine level of >0.9 milligrams/deciliter (P<.01); the presence of an antiviral agent (P=.0501); the presence of an antibacterial agent (P=.0519); the presence of an antifungal agent (P<.05); and leukemia, lymphoma, or multiple myeloma diagnosis (P<.05). Using 5 of these factors, the RTP-BMT index was formulated to determine the likelihood of return to the primary team.

CONCLUSIONS

Patients with BMT have a high rate of transfer from the inpatient rehabilitation unit back to the primary service. The RTP-BMT index score can be a useful tool to help clinicians predict the likelihood of return to the primary acute care service.