Volume 60, Issue 4 p. 726-732
Brief Reports

Association Between Prestroke Disability and Inpatient Mortality and Length of Acute Hospital Stay After Acute Stroke

Chun S. Kwok MBBS

Chun S. Kwok MBBS

Stroke Research Group, Norfolk and Norwich University Hospital

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Allan Clark PhD

Allan Clark PhD

Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK

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Gary A. Ford MBB, Chir

Gary A. Ford MBB, Chir

Stroke Research Group, Institute for Ageing and Health, Newcastle University, Royal Victoria Infirmary, Newcastle, UK

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Ramesh Durairaj MD

Ramesh Durairaj MD

Department of Medicine for the Elderly, University Hospital Aintree, Liverpool, UK

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Anand K. Dixit MD

Anand K. Dixit MD

Freeman Hospital Stroke Service, Newcastle Hospitals National Health Service Trust, Newcastle upon Tyne, UK

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John Davis PG, Dip

John Davis PG, Dip

Stroke Research Group, Institute for Ageing and Health, Newcastle University, Royal Victoria Infirmary, Newcastle, UK

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Anil K. Sharma MD

Anil K. Sharma MD

Department of Medicine for the Elderly, University Hospital Aintree, Liverpool, UK

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John F. Potter DM

John F. Potter DM

Stroke Research Group, Norfolk and Norwich University Hospital

Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK

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Phyo K. Myint MD

Corresponding Author

Phyo K. Myint MD

Stroke Research Group, Norfolk and Norwich University Hospital

Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK

Clinical Gerontology Unit, University of Cambridge, Cambridge, UK

Address correspondence to Dr. Phyo Kyaw Myint, Norwich Medical School, Department of Medicine, University of East Anglia, Norwich, NR4 7TJ, UK. E-mail: [email protected]Search for more papers by this author
First published: 08 February 2012
Citations: 39

Abstract

Objectives

To examine the prognostic value of prestroke disability in predicting inpatient mortality and length of hospital stay (LOS) independent of age, sex, and stroke type and severity.

Design

Retrospective analysis of prospectively collected stroke registers.

Setting

United Kingdom.

Participants

Fourteen thousand four hundred thirty-seven individuals (52.9% female, mean age 75.4 ± 12.1) with stroke (82% ischemic) admitted to three university hospitals.

Measurements

Data were examined from three hospital registers: Aintree (2005–2010), Newcastle (2000–2005), and Norwich (1997–2010). Risk of inpatient death and prolonged hospital stay according to prestroke disability using the modified Rankin Score (mRs) were assessed using logistic regression adjusting for age, sex, and stroke subtype (ischemic vs hemorrhagic) and severity.

Results

Inpatient death was 20.8%. In fully adjusted models, higher prestroke mRs was associated with significantly greater risk of mortality (for mRs = 1, 2, 3, 4, and 5 vs mRs = 0: odds ratio (OR)=1.28, 95% confidence interval (CI)=1.09–1.50; OR = 1.50, 95% CI = 1.29–1.75; OR = 1.85, 95% CI = 1.60–2.13; OR = 2.56, 95% CI = 2.15–3.04; and OR = 4.48, 95% CI = 3.47–5.80, respectively). The relationship appeared to be linear, and each point increase in mRs equated to being approximately 5 years older. Although age and stroke type appear to be strong independent predictors of LOS, premorbid mRs also predicted longer LOS regardless of discharge status. The predictability of the model using these parameters was very good (receiver operating characteristic: 0.82 for death and 0.65–0.70 for LOS).

Conclusion

Prestroke disability predicts inpatient death and LOS, independent of age, sex, and stroke type and severity. Whether this is related to mental or physical disability should be examined in future prospective studies.