1560 - Use of NIH Stroke Scale and Stroke Rehabilitation to evaluate Survival Probability among patients with history of Cerebral Vascular Accident

Stroke rehabilitation is known to decrease mortality and readmission among stroke patients. Standard protocol uses the National Institute of Health Stroke Scale (NIHSS) to determine the severity of a patient’s stroke and predict next steps. Patients with mild NIHSS scores (< 5) are often discharged home, moderate NIHSS (5-15) often need acute inpatient rehabilitation, and moderate-severe or above (16+) may need long-term skilled care. This study investigates the 10-year survival probability of stroke patients based on their NIHSS and admission to stroke rehabilitation.

Design: Retrospective analysis using TrinetX database. Patients were stratified into the following groups: moderate (NIHSS 5-15) with rehabilitation, moderate without rehabilitation, moderate-severe to severe (NIHSS 16-42) with rehabilitation, moderate-severe to severe without rehabilitation. Groups were cohort matched to ensure similar distribution of gender, age, ethnicity, and past medical history. Kaplan-Meier Analysis was conducted to assess 10-year survival probability.

Results:

There were 23,640 patients each in the moderate with rehabilitation group and the moderate without rehabilitation group. There were 9,550 patients each in the moderate-severe to severe with rehabilitation group and moderate-severe to severe without rehabilitation group. 10-year survival probability of the moderate with rehabilitation group was 60.476% and in the moderate with no rehabilitation it was 52.382%. Among the moderate-severe to severe cohort, 10-year survival probability was 52.097% for the rehabilitation group and 28.476% for the no rehabilitation group. 

Conclusions: Both groups had higher survival probability with use of rehabilitation. The moderate-severe to severe group saw a greater increase in survival than the moderate group, underscoring the importance of stroke rehabilitation. A goal of this study is to open discussion on barriers that inhibit our moderate to severe stroke patients from undergoing rehabilitation. This may include unstable housing, ability to undergo physical therapy, social support, and access to rehabilitation. We hope this project emphasizes the importance of patient-centered care.