Pinto Shanti M, Galang Gary
From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Am J Phys Med Rehabil. 2017 Jun;96(6):367-373. doi: 10.1097/PHM.0000000000000643.
The aim of this study was to investigate the impact of venous thromboembolism (VTE) on rate of acute care hospital transfer, inpatient rehabilitation (IPR) length of stay (LOS), and functional outcomes.
This was a retrospective cohort study of 2312 consecutive patient discharges from a single IPR facility over an 18-month period.
When age, sex, reason for admission, and admission Functional Independence Measure (FIM) scores were controlled for, those with VTE had nearly 2 times greater odds for transfer to acute care hospital than did those without a diagnosis of VTE. Inpatient rehabilitation LOS was 4.700 days (95% confidence interval [CI], 2.956-6.445 days) longer for those with a diagnosis of VTE prior to IPR admission and 2.287 days (95% CI, 1.026-3.547 days) longer for those with a diagnosis of VTE during IPR admission compared with those without a diagnosis of VTE. There was no difference in FIM change based on VTE diagnosis. Venous thromboembolism diagnosis during IPR was associated with a significant decrease in FIM efficiency (-0.358; 95% CI, -0.654 to -0.062) if diagnosed during IPR admission, but there was no difference in FIM efficiency if VTE was diagnosed prior to IPR.
Patients with a diagnosis of VTE were more likely to be transferred to the acute care hospital and have longer IPR LOS independent of admission FIM scores. It is important to prevent development of VTE.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) understand the association of venous thromboembolism (VTE) diagnosis with acute hospital transfer and inpatient rehabilitation length of stay; (2) identify reasons for acute hospital transfer in patients diagnosed with VTE; and (3) understand the relationship between VTE diagnosis and functional outcomes during inpatient rehabilitation.
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
本研究旨在调查静脉血栓栓塞症（VTE）对急性护理医院转诊率、住院康复（IPR）住院时长（LOS）及功能结局的影响。
这是一项回顾性队列研究，研究对象为在18个月期间内从单一IPR机构连续出院的2312例患者。
在对年龄、性别、入院原因及入院时功能独立性评定量表（FIM）评分进行控制后，VTE患者转入急性护理医院的几率比未诊断出VTE的患者高出近2倍。与未诊断出VTE的患者相比，IPR入院前被诊断为VTE的患者住院康复LOS长4.700天（95%置信区间[CI]，2.956 - 6.445天），IPR入院期间被诊断为VTE的患者住院康复LOS长2.287天（95%CI，1.026 - 3.547天）。基于VTE诊断的FIM变化无差异。如果在IPR入院期间诊断出VTE，IPR期间的静脉血栓栓塞症诊断与FIM效率显著降低相关（-0.358；95%CI，-0.654至-0.062），但如果在IPR之前诊断出VTE，FIM效率无差异。
诊断为VTE的患者更有可能被转至急性护理医院，且IPR LOS更长，与入院FIM评分无关。预防VTE的发生很重要。
高级。认证：学术物理医学与康复医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复医师协会将此活动指定为最多1.5个美国医学协会医师认可的继续教育第1类学分™。医生应仅根据其参与活动的程度索取学分。
