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The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study

Department of Neurological Rehabilitation, Rehabilitation Centre Groot Klimmendaal Arnhem, The Netherlands

J van Limbeek

Department of Rehabilitation Medicine and SMK Research, Sint Maartenskliniek Nijmegen, The Netherlands

G Peusens

Department of Rehabilitation Medicine, VieCuri Medical Centre Noord-Limburg, The Netherlands

M Rulkens

K Dankoor

Department of Rehabilitation Medicine, Rijnstate Hospital Arnhem, The Netherlands

M Vermeulen

Department of Neurology, The Netherlands

R J de Haan

Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre Amsterdam, The Netherlands

Objective: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit.

Methods: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and social subdomains, were scored and analysed by binary logistic regression analysis. The outcome of the research consisted of the various discharge destinations.

Results: The overall predictive value of the discharge model is high (91%). Factors predictive of a poor discharge outcome are a low Barthel Index score (odds ratio (OR) 0.78 per point increase; p &lt 0.001), a poor sitting balance (OR 5.96; p &lt 0.001), a depression (OR 7.23; p &lt 0.001), poststroke cognitive disability (OR 3.51; p = 0.007) and older age (OR 1.05 per point increase; p = 0.008). If present, a personality disorder, premorbid cognitive disability and premorbid functional disability all show a tendency towards poor discharge outcome, but these factors did not reach statistical significance in this study, possibly due to their low prevalence. Readiness of the family circle to provide support was only significant in the univariate analysis.

Conclusions: Somatic, biological and psychological factors predict the discharge outcome. Functional and cognitive factors play a decisive role in the future ability to live independently after a stroke. The prognostic importance of social factors could not be demonstrated. Urinary incontinence did not emerge as a prognostic factor. This is in contrast to scientific findings till now, but in accordance with clinical experience.

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