Incidence of and risk factors for medical complications during stroke rehabilitation

• Published in: Stroke (1970) 2001-02, Vol.32 (2), p.523-529
• Main Authors: ROTH, Elliot J, LOVELL, Linda, HARVEY, Richard L, HEINEMANN, Allen W, SEMIK, Patrick, DIAZ, Sylvia
• Format: Article
• Language: English
• Subjects: Accidental Falls - statistics & numerical data; Angina Pectoris - diagnosis; Angina Pectoris - epidemiology; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - epidemiology; Biological and medical sciences; Cohort Studies; Comorbidity; Demography; Female; Humans; Incidence; Inpatients - statistics & numerical data; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Neurology; Odds Ratio; Pain - diagnosis; Pain - epidemiology; Pneumonia - diagnosis; Pneumonia - epidemiology; Prospective Studies; Risk Assessment; Risk Factors; Stroke - epidemiology; Stroke Rehabilitation; Treatment Outcome; Urinary Tract Infections - diagnosis; Urinary Tract Infections - epidemiology; Vascular diseases and vascular malformations of the nervous system; Venous Thrombosis - diagnosis; Venous Thrombosis - epidemiology
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.32.2.523

The aims of this study were to examine the frequency, types, and clinical factors associated with medical complications that occur during inpatient rehabilitation and to identify risk factors for complications that require a transfer to an acute care facility. A cohort of 1029 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke information, impairment, preexisting medical conditions, and admission laboratory abnormalities were recorded. Medical complications, defined as new or exacerbated medical problems, were documented for each patient. Complications that required transfer off rehabilitation were noted. Univariate and multiple logistic regression analyses were used to determine factors that were associated with risk of medical complications and risk of transfer off rehabilitation. Seventy-five percent of patients experienced >/=1 medical complication during rehabilitation. Significant factors for the development of any medical complication included greater neurological deficit (odds ratio [OR], 4.10; confidence interval [CI], 1.88 to 8.91), hypoalbuminemia (OR, 1.71; 95% CI, 1.15 to 2.52), and history of hypertension (OR, 1.81; 95% CI, 1.27 to 2.59). Nineteen percent of patients had a medical complication that required transfer to an acute care facility. Significant factors for transfers were elevated admission white blood cell counts (OR, 1.92; 95% CI, 1.32 to 2.79), low admission hemoglobin levels (OR, 1.89; 95% CI, 1.32 to 2.68), greater neurological deficit (OR, 2.46; 95% CI, 1.37 to 4.39), and a history of cardiac arrhythmia (OR, 1.79; 95% CI, 1.18 to 2.67). Medical complications are common among patients undergoing stroke rehabilitation. A significant number of these medical complications may require a transfer to an acute facility.