To determine if patient demographics or severity of illness predict hospital readmission within 30 days following spontaneous intracerebral hemorrhage (ICH), to identify readmission associations that may be modifiable at the single center level, and to determine the impact of readmission on outcomes.
We collected demographic, clinical, and hospital course data for consecutive patients with spontaneous ICH enrolled in an observational study. Readmission within 30 days was determined retrospectively by an automated query with manual confirmation. We identified the reason for readmission and tested for associations between readmission and functional outcomes using modified Rankin Scale (mRS, a validated functional outcome measure from 0, no symptoms to 6, death) scores before ICH and at 14 days, 28 days, and three months after ICH.
Neurologic intensive care unit of a tertiary care hospital.
Critically ill patients with spontaneous ICH.
Patients received standard critical care management for ICH.
Measurements and Main Results
Of 246 patients (mean age 65 years, 51% female), 193 (78%) survived to discharge. Of these, 22 (11%) were re-admitted at a median of 9 [interquartile range (IQR) 4–15] days. The most common readmission diagnoses were infections after discharge (N=10) and vascular events (N=6). Age, history of stroke and hypertension, severity of neurologic deficit at admission, APACHE acute physiology score, ICU and hospital length of stay, ventilator free days, days febrile, and surgical procedures were not predictors of readmission. History of coronary artery disease was associated with readmission (p=0.03). Readmitted patients had similar mRS and severity of neurologic deficit at 14 days but higher (worse) mRS scores at three months (median [IQR], 5 [3–6] vs. 3 [1–4], p=0.01).
Severity of illness and hospital complications were not associated with 30-day readmission. The most common indication for readmission was infection after discharge, and readmission was associated with worse functional outcomes at three months. Preventing readmission after ICH may depend primarily on optimizing care after discharge and improve functional outcomes at three months.