• Daniel J Schlegel, David Tanne, Andrew M Demchuk, Steven R Levine, Scott E Kasner, and Multicenter rt-PA Stroke Survey Group.
• Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce Street, 3W Gates Building, Philadelphia, PA 19104, USA.
• Arch Neurol Chicago. 2004 Jul 1; 61 (7): 1061-4.

BackgroundEarly determination of discharge destination after acute stroke may promote earlier rehabilitation and reduce costs by shortening the duration of hospitalization.ObjectiveTo determine whether the National Institutes of Health Stroke Scale (NIHSS) score predicts disposition in stroke patients treated with thrombolysis.DesignCohort study.SettingAcademic and community hospitals from 3 countries.PatientsFive hundred forty-six patients with acute ischemic stroke treated with recombinant tissue plasminogen activator (rt-PA).InterventionsMedical records were reviewed for demographic information, vascular risk factors, location of stroke, initial NIHSS score, acute hospital disposition, and complications of symptomatic or asymptomatic intracerebral hemorrhage (ICH).Main Outcome MeasureDischarge destination to home, acute rehabilitation, or nursing facility.ResultsIn multinomial regression analysis, increasing NIHSS score was a robust and independent predictor of discharge to rehabilitation or nursing facilities, roughly doubling for each 5-point increment. Patients who developed symptomatic ICH were never discharged to home, but asymptomatic ICH had no significant independent effect on disposition.ConclusionsStroke severity as determined by the admission NIHSS score is the major independent predictor of disposition after hospitalization and treatment with rt-PA for acute stroke in a broad-based population. However, symptomatic ICH after rt-PA is a catastrophic event that may preclude discharge to home.

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