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Decline in Rehab Transfers Among Rehab-Eligible Stroke Patients During the COVID-19 Pandemic.
Thau, Lauren; Siegal, Taylor; Heslin, Mark E; Rana, Ameena; Yu, Siyuan; Kamen, Scott; Chen, Austin; Vigilante, Nicholas; Gallagher, Sheri; Wegner, Kevin; Thon, Jesse M; Then, Ryna; Patel, Pratit; Yeager, Terri; Jovin, Tudor G; Kumar, Rohini J; Owens, David E; Siegler, James E.
  • Thau L; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Siegal T; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Heslin ME; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Rana A; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Yu S; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Kamen S; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Chen A; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Vigilante N; Cooper Medical School of Rowan University, Camden, New Jersey, 08103.
  • Gallagher S; Department of Physical Medicine and Rehabilitation, Cooper University Hospital, Camden, New Jersey, 08103.
  • Wegner K; Department of Physical Medicine and Rehabilitation, Cooper University Hospital, Camden, New Jersey, 08103.
  • Thon JM; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, 08103.
  • Then R; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, 08103.
  • Patel P; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, 08103.
  • Yeager T; Department of Physical Medicine and Rehabilitation, Cooper University Hospital, Camden, New Jersey, 08103.
  • Jovin TG; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, 08103.
  • Kumar RJ; Department of Physical Medicine and Rehabilitation, Cooper University Hospital, Camden, New Jersey, 08103.
  • Owens DE; Department of Physical Medicine and Rehabilitation, Cooper University Hospital, Camden, New Jersey, 08103.
  • Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, 08103. Electronic address: siegler-james@cooperhealth.edu.
J Stroke Cerebrovasc Dis ; 30(8): 105857, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1213403
Semantic information from SemMedBD (by NLM)
1. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
2. Acute Cerebrovascular Accidents PROCESS_OF Survivors
Subject
Acute Cerebrovascular Accidents
Predicate
PROCESS_OF
Object
Survivors
3. Cerebrovascular accident PROCESS_OF Survivors
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Survivors
4. GJA1 gene|GJA1 AUGMENTS Disability
Subject
GJA1 gene|GJA1
Predicate
AUGMENTS
Object
Disability
5. Cerebrovascular accident COEXISTS_WITH COVID-19
Subject
Cerebrovascular accident
Predicate
COEXISTS_WITH
Object
COVID-19
6. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
7. Acute Cerebrovascular Accidents PROCESS_OF Survivors
Subject
Acute Cerebrovascular Accidents
Predicate
PROCESS_OF
Object
Survivors
8. Cerebrovascular accident PROCESS_OF Survivors
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Survivors
9. GJA1 gene|GJA1 AUGMENTS Disability
Subject
GJA1 gene|GJA1
Predicate
AUGMENTS
Object
Disability
10. Cerebrovascular accident COEXISTS_WITH COVID-19
Subject
Cerebrovascular accident
Predicate
COEXISTS_WITH
Object
COVID-19
ABSTRACT

OBJECTIVE:

To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic. MATERIALS AND

METHODS:

We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression.

RESULTS:

Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p<0.001) despite a significant increase in discharge disability (median discharge mRS 4 [IQR 2-4] vs. 2 [IQR 1-3], p<0.001) during the pandemic.

CONCLUSIONS:

Admission for stroke during the COVID-19 pandemic was associated with a significantly lower probability of being discharged to an IRF. This effect persisted despite adjustment for predictors of IRF disposition, including functional disability at discharge. Potential reasons for this disparity are explored.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Practice Patterns, Physicians&apos; / Patient Transfer / Stroke / Stroke Rehabilitation / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Practice Patterns, Physicians&apos; / Patient Transfer / Stroke / Stroke Rehabilitation / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2021 Document Type: Article