Early Scandinavian stroke scale scores as a predictive tool for rehabilitation and discharge planning

Abstract

Background and Rationale: Early prognostication regarding the need for inpatient rehabilitation or early discharge planning would be useful early in the course of a patient’s admission. Clinical tools are available to determine a patient’s current level of stroke severity, but it is unknown whether a stroke severity scale can accurately predict a patient’s discharge destination. Our centre uses the Scandinavian Stroke Scale (SSS) and we hypothesised that SSS would predict early discharge and the need for rehabilitation. Methods: Details of age, gender, history of previous stroke, SSS in first 24 hours of admission, and discharge destination from acute care were collected on consecutive patients over an 8 months period. SSS scores were divided into three groups: good (> 50), intermediate (30–49) and poor (< 30). Data were analysed to see how well the admission SSS scores predicted discharge destination. Results: In total, 162 strokes were analysed. Mean age was 72 years, 52.5% were male, and 33.3% had prior stroke. 88.9% of strokes were ischaemic. 69 (90.8%) of the 76 patients with an SSS of >50 were discharged directly home from acute care. 5 (6.6%) and 2 (2.6%) patients went to rehabilitation and residential care, respectively. Of the 30 patients with a SSS of <30, 60% had died or required residential care. No patient was discharged directly home from this group. Of the 56 patients with a SSS score between 30–49, 52% needed rehabilitation. Conclusion: An admission SSS of >50 was highly predictive of discharge home while a score of <30 was highly predictive of death or lack of early independence. Over 90% of all patients who died scored less than 30. A score of 30–49 correlated was not predictive of discharge destination. Further longitudinal studies are needed to validate the predictive potential of the SSS and other clinical stroke severity scales. Show more