2024 American Academy of Neurology Abstract Website

Objective:

This retrospective cohort study compared length of stay among stroke patients referred to brain injury medicine rehabilitation centers (BRC) vs non-specialized acute rehabilitation centers (ARC).

Background:

Early rehabilitation improves stroke outcomes. However, patients slated for discharge to ARC often sustain prolonged hospital stays likely due to limited facility availability and inefficient discharge planning. Specialized BRC provide enhanced cognitive rehabilitation services linked to greater improvement in socioprofessional participation and quality of life, yet they are less abundant than ARC and are typically limited to urban settings. It remains unclear whether the average length of stay is longer among patients referred to BRCs compared to ARC.

Design/Methods:

We reviewed healthcare records of stroke patients admitted to an academic hospital between 1/2022 and 12/2022. Demographics, medical history, and referral destinations were recorded. Linear regression was used to analyze the effect of referral destination on log-transformed hospital length of stay while controlling for confounders.

Results:

Among 122 patients, 17 were referred to BRC, while 105 were referred to ARC. Patients referred to BRC were more often White (46.7% vs. 20.0%, p=0.0066), had higher average NIHSS (15.0 vs. 7.3, p<.0001), and had higher rates of hemorrhagic strokes (52.9% vs. 19.0%, p=0.00232) and coronary artery disease (29.4% vs. 10.5%, p=0.0319). Logistic regression indicated that referral to BRC significantly increased length of stay (p=0.0006) by 42.17%, or 4.6 days compared to ARC, after adjusting for age, race, and ethnicity.

Conclusions:

Patients referred to BRC had significantly longer hospital stays compared to those referred to ARC. Health care disparities must be considered to prevent discharge delays among stroke patients who require specialized care.