急性重症卒中后的住院康复：美国国立卫生研究院卒中量表在其他潜在出院目的地预测因素中的预测价值
Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination.
作者信息
Tarvonen-Schröder Sinikka, Niemi Tuuli, Koivisto Mari
机构信息
Neurocenter, Turku University Hospital, Turku, Finland.
Department of Clinical Neurosciences, University of Turku, Turku, Finland.
出版信息
Adv Rehabil Sci Pract. 2023 May 20;12:27536351231157966. doi: 10.1177/27536351231157966. eCollection 2023 Jan-Dec.
BACKGROUND
Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied.
AIM
The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation.
MATERIAL AND METHODS
On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression.
RESULTS
70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized.
CONCLUSION
The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
背景
针对重症中风康复期住院患者出院去向预测因素的研究较少。康复入院时美国国立卫生研究院卒中量表（NIHSS）评分以及其他可用的潜在预测因素的预测价值尚未得到研究。
目的
这项回顾性干预研究的目的是确定24小时及康复入院时NIHSS评分相对于其他在康复入院时常规收集的潜在社会人口学、临床和功能预测因素对出院去向的预测准确性。
材料与方法
在一所大学医院的专业住院康复病房，招募了156名连续的康复患者，其24小时NIHSS评分≥15分。在康复入院时，使用逻辑回归分析常规收集的可能与出院去向（社区与机构）相关的变量。
结果
70名（44.9%）康复患者出院至社区，86名（55.1%）出院至机构护理。出院回家的患者更年轻，仍在工作的比例更高，急性期吞咽困难/鼻饲或放弃心肺复苏决定的情况更少，从中风发作到康复入院的时间更短，入院时损伤（NIHSS评分、轻瘫、忽视）和残疾（功能独立性测量[FIM]评分、步行能力）较轻，且住院期间功能改善比入住机构的患者更快、更显著。
结论
康复入院时社区出院的最具影响力的独立预测因素是较低的入院NIHSS评分、步行能力和较年轻的年龄，其中NIHSS最为有力。NIHSS每增加1分，出院至社区的几率降低16.1%。三因素模型解释了65.7%的社区出院情况和81.9%的机构出院情况，总体预测准确性为74.7%。仅入院NIHSS评分对应的数字分别为58.6%、70.9%和65.4%。
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