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.