Cho et al reported a risk score for post-stroke patients. This can help to determine if discharge location is appropriate for the patient. The patients are from the University of Tennessee at Chattanooga.
Patient selection: hospitalized adult after stroke
Parameters:
(1) sex
(2) age
(3) race
(4) stroke type
(5) comorbidity
(6) source of admission
(7) type of insurance
|
Parameter |
Finding |
Points |
|
sex |
male |
0 |
|
|
female |
1 |
|
age |
18 to 64 years |
0 |
|
|
65 to 74 years |
1 |
|
|
>= 75 years |
3 |
|
race |
white |
0 |
|
|
black |
1 |
|
|
other |
-1 |
|
stroke type |
ischemic |
0 |
|
|
meningeal hemorrhage |
1 |
|
|
intracerebral hemorrhage |
5 |
|
comorbidity |
diabetes |
1 |
|
|
hypercholesterolemia |
-1 |
|
|
atrial fibrillation (AF) |
2 |
|
|
chronic kidney disease |
1 |
|
|
heart disease other than AMI and AF |
1 |
|
|
TIA |
1 |
|
|
acute heart attack |
1 |
|
|
alcohol habit |
2 |
|
|
drug habit |
1 |
|
|
smoking |
-1 |
|
|
family history (of what?) |
-2 |
|
|
depression |
2 |
|
|
other (exclude obesity, peripheral arterial disease, hypertension) |
2 |
|
source of admission |
nonhealthcare facility |
0 |
|
|
clinic referral |
0 |
|
|
transfer from hospital |
1 |
|
|
skilled nursing facility |
13 |
|
|
other |
4 |
|
type of insurance |
Medicare or Medicaid |
0 |
|
|
private insurance |
-3 |
|
|
other |
-2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• A score < 9 is predicted to be discharged home.
• A score >= 9 is predicted to be discharged to a facility.
• The discharge decision was "validated" based on the readmission rate (the conjecture was that a patient properly discharged would be less likely to be readmitted).
• A patient with a high score may not be a good candidate to discharge home.
