Length of Stay in Rehabilitation is Associated with Admission Neurologic Deficit and Discharge Destination

Objective: This study explores the link between neurologic deficit as measured by the National Institutes of Health Stroke Scale (NIHSS), and its relationship to length of stay (LOS) and discharge destination. Design: A retrospective chart review was completed of 54 patients admitted for rehabilitation after experiencing a cerebrovascular accident. Setting: The study was completed in an acute inpatient rehabilitation stroke unit in a large urban tertiary care medical center. Participants: Patients were included in this analysis if their record contained an NIHSS score on both admission and discharge, if they had neuroimaging documentation of an acute hemorrhagic or ischemic stroke, and if they were not transferred away from the rehabilitation unit during their stay. Of 54 cases reviewed, 47 were ultimately included. Main Outcome Measurements: Independent variables included were NIHSS admission and discharge scores, change in score from admission to discharge, discharge destination, age, gender, type of stroke, and use of tissue plasminogen activator. These were examined against the dependent variable, LOS. Results: Greater admission NIHSS scores predicted longer hospital stays. Mean admission and discharge scores were significantly greater for patients discharged to subacute facilities, and LOS was also longer for these patients compared with those discharged to the community. Surprisingly, age was inversely related to LOS, admission score, and discharge score. Conclusion: Stroke remains one of the most common reasons for admission to acute care hospitals. The authors know of no studies that have examined the rehabilitation aspect of care incorporating the NIHSS in this manner. This study draws a connection between neurologic impairment by using the NIHSS and LOS and discharge destination in an acute inpatient rehabilitation stroke unit. In the future, multidisciplinary rehabilitation teams may consider using this measure to predict LOS and disposition at discharge from inpatient rehabilitation.