Predictors of Acute Transfer and Mortality Within 6 Months From Admission to an Inpatient Rehabilitation Facility for Patients With Brain Tumors.

OBJECTIVE: To obtain useful information for clinicians in evaluating patients with brain tumors for transfer to and subsequent care in inpatient rehabilitation facilities (IRFs). DESIGN: Retrospective chart review. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: A total of 208 adults with either initial or recurrent brain tumors who were admitted to an IRF between January 2017 and December 2018 after an acute hospitalization. INTERVENTIONS: None MAIN OUTCOME MEASURES: Transfer from an IRF to an acute care hospital and mortality within 6 months from admission to an IRF. RESULTS: Of the 208 patients who met inclusion criteria, 20.2% were transferred to an acute care hospital during the IRF stay, which was associated with prior chemotherapy, steroid use, and laterality of tumor. In total, 36.9% of patients with brain tumors died within 6 months of an IRF admission that was associated with recurrent tumor diagnosis, prior chemotherapy, prior neurosurgical intervention, prior neurostimulant use, use of steroids, isocitrate dehydrogenase and O6-methyl-guanyl-methyl-transferase biomarkers, and laterality and location of tumor. CONCLUSIONS: Patients with brain tumors have a notable potential for acute hospital transfer and mortality within 6 months of IRF stay, with several tumor- and treatment-related risk factors. This information can help identify functional goals, identify high risk patients, enable closer clinical monitoring, and facilitate focused care discussions at IRFs.

Trunk Injuries in Athletes.

ABSTRACT: Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme.

BACKGROUND: Prior studies of inpatient rehabilitation of patients with brain tumor demonstrate similar functional gains as compared to other rehabilitation populations. There are few studies specifically examining the rehabilitation of patients with glioblastoma. OBJECTIVE: To compare functional outcomes between matched patients admitted to acute inpatient rehabilitation after initial diagnosis of glioblastoma (iGBM) and after diagnosis of recurrent glioblastoma (rGBM). DESIGN: A retrospective, case-matched study using descriptive statistics compared demographic information and functional outcomes as designated by the Functional Independence Measure (FIM) score. SETTING: A single, freestanding inpatient rehabilitation hospital. PATIENTS: Over a 20-month period, 25 patients with iGBM were matched with 25 patients admitted to an inpatient rehabilitation facility with rGBM by the following criteria: (1) side of lesion (left/right hemisphere), (2) admission total FIM score within 10 points, (3) age within 10 years, and (4) gender. Nineteen of the 25 patients in each group were matched meeting all criteria, and 6 of the 25 patients were matched meeting three out of four criteria. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The primary outcome measures were differences in functional outcomes as measured by FIM scores. RESULTS: There were no statistically significant differences (P < .05) between the groups in mean admission FIM scores, discharge FIM scores, FIM gains, and FIM efficiencies. There were no statistically significant differences in the development of complications during acute rehabilitation and transfer rate to acute care hospital. Sixty-four percent of patients in both groups were able to be discharged home. CONCLUSIONS: This study demonstrated no statistically significant differences in functional outcomes between matched patients admitted with iGBM compared to rGBM. Further studies are indicated to examine the rehabilitation outcomes of patients with rGBM in inpatient rehabilitation.

Number needed to treat for stroke thrombectomy based on a systematic review and meta-analysis.

The positive results of recent clinical trials examining endovascular treatment of acute stroke were the culmination of nearly two decades of studies of endovascular stroke treatment. We systematically reviewed this body of work, evaluated the strength of evidence, and performed a meta-analysis to define the clinical impact of these investigations. Terms were entered into search engines in a systematic fashion. Articles were reviewed independently by study authors, graded for level of evidence, and combined in a meta-analysis. The overall body of evidence was evaluated using GRADE criteria. Our search yielded 948 articles. Twenty-five met predefined inclusion criteria. We identified 12 grade I, 1 grade II, 5 grade III, and 7 grade IV studies (κ=0.86). Meta-analysis for independence at 90days showed a benefit of endovascular treatment (grade I studies OR 1.58 [1.20-2.07]). When limiting the analysis to studies using stent retriever, the OR increased to 2.44 (1.77-3.36). The number needed to treat (NNT) was 8. Endovascular treatment was not associated with increased symptomatic intracranial hemorrhage, and forgoing endovascular treatment was associated with death at 90 days. The quality of evidence according to GRADE criteria was "moderate." In summary, we found impressive evidence for a benefit of endovascular treatment of acute stroke, particularly when using stent retriever devices. Our meta-analysis is unique in that it includes all studies related to this topic and defines the clinical impact of the data, providing NNT. We show that thrombectomy is among the most effective stroke treatments currently available.