Article

By using data from Department of Veterans Affairs (VA) national
databases, this article presents and internally validates a 1-year all-cause
mortality prediction index after hospitalization for acute stroke. DESIGN: An
observational cohort. SETTING: VA medical centers. PARTICIPANTS: Veterans with a
diagnosis of a new stroke who were discharged between October 1, 2006, and
September 30, 2008. MAIN OUTCOME MEASURE: Death due to any cause that occurred
between the index hospital discharge date and the 1-year anniversary of that
date. RESULTS: Within 1-year after discharge, 1542 (12.3%) of the total 12,565
patients had died. Seventeen risk factors known at the point of hospital
discharge remained in the predictive model of 1-year postdischarge mortality
after backward selection, including advanced age, admission from extended care,
type of stroke, 8 comorbid conditions, 4 types of procedures that occurred during
the index hospitalization, hospital length of stay (longer than 3 weeks), and
discharge location. We assigned a score to each variable in the final model and a
risk score was determined for each patient by adding up the points for all risk
factors present. According to these risk scores, the patients were divided into
approximate quartiles that yielded low, moderate, high, and highest mortality
likelihood strata. The risk of 1-year mortality ranged from 2.24% in the lowest
quartile to 29.50% in the highest quartile in the derivation cohort and from
2.11%-30.77% in the validation cohort. Model discrimination demonstrated an area
under the receiver operating characteristic curve of 0.785 in the derivation
cohort and 0.787 in the validation cohort. The Hosmer-Lemeshow goodness of fit
indicated that the model fit was adequate (P = .69). CONCLUSION: When using
readily available data, a simple index that stratifies stroke patients at
hospital discharge according to low, moderate, high, and highest likelihood of
all-cause 1-year mortality is feasible and can inform the postdischarge planning
process, depending on level of risk.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS