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Predictors of 30-Day Readmission After Intracerebral Hemorrhage: A Single-Center Approach for Identifying Potentially Modifiable Associations With Readmission*

Liotta, Eric M. MD1; Singh, Mandeep MD2; Kosteva, Adam R. MA1; Beaumont, Jennifer L. MS3; Guth, James C. MD1; Bauer, Rebecca M. MD, MPH2; Prabhakaran, Shyam MD, MS1; Rosenberg, Neil F. MD1; Maas, Matthew B. MD1,2; Naidech, Andrew M. MD, MSPH1,2

doi: 10.1097/CCM.0b013e318298a10f
Neurologic Critical Care

Objective: To determine whether patient’s demographics or severity of illness predict hospital readmission within 30 days following spontaneous intracerebral hemorrhage, to identify readmission associations that may be modifiable at the single-center level, and to determine the impact of readmission on outcomes.

Design: We collected demographic, clinical, and hospital course data for consecutive patients with spontaneous intracerebral hemorrhage enrolled in an observational study. Readmission within 30 days was determined retrospectively by an automated query with manual confirmation. We identified the reason for readmission and tested for associations between readmission and functional outcomes using modified Rankin Scale (a validated functional outcome measure from 0, no symptoms, to 6, death) scores before intracerebral hemorrhage and at 14 days, 28 days, and 3 months after intracerebral hemorrhage.

Setting: Neurologic ICU of a tertiary care hospital.

Patients: Critically ill patients with spontaneous intracerebral hemorrhage.

Interventions: Patients received standard critical care management for intracerebral hemorrhage.

Measurements and Main Results: Of 246 patients (mean age, 65 yr; 51% female), 193 patients (78%) survived to discharge. Of these, 22 patients (11%) were readmitted at a median of 9 days (interquartile range, 4–15 d). The most common readmission diagnoses were infections after discharge (n = 10) and vascular events (n = 6). Age, history of stroke and hypertension, severity of neurologic deficit at admission, Acute Physiology and Chronic Health Evaluation score, ICU and hospital length of stay, ventilator-free days, days febrile, and surgical procedures were not predictors of readmission. History of coronary artery disease was associated with readmission (p = 0.03). Readmitted patients had similar modified Rankin Scale and severity of neurologic deficit at 14 days but higher (worse) modified Rankin Scale scores at 3 months (median [interquartile range], 5 [3–6] vs 3 [1–4]; p = 0.01).

Conclusions: Severity of illness and hospital complications were not associated with 30-day readmission. The most common indication for readmission was infection after discharge, and readmission was associated with worse functional outcomes at 3 months. Preventing readmission after intracerebral hemorrhage may depend primarily on optimizing care after discharge and may improve functional outcomes at 3 months.

1Department of Neurology, Northwestern University—Feinberg School of Medicine, Chicago, IL.

2Department of Anesthesiology, Northwestern University—Feinberg School of Medicine, Chicago, IL.

3Department of Medical Social Sciences, Northwestern University—Feinberg School of Medicine, Chicago, IL.

* See also p. 2830.

Dr. Prabhakaran has received royalties from UpToDate. Dr. Naidech serves as a medical safety monitor for two unrelated National Institutes of Health funded trials and has received unrelated research funding from the Northwestern Memorial Foundation. He has also received grant support from Gaymar and Astellas Pharma US and has received travel reimbursements from the Korean Society of Critical Care Medicine and the Indian Society of Critical Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins