Article
Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study12

https://doi.org/10.1016/S0003-9993(03)00009-1Get rights and content

Abstract

Diamond PT, Gale SD, Evans BA. Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study. 2003:84:964–7.

Objective:

To examine the association between initial hematocrit level at the time of ischemic stroke, discharge destination, and resource utilization.

Design:

Case series.

Setting:

University hospital.

Participants:

A total of 1012 consecutive patients with ischemic stroke admitted to a university health system between August 3, 1995, and June 24, 1999.

Interventions:

Not applicable.

Main Outcome Measures:

Length of stay, hospital cost, and discharge disposition.

Results:

Of 1012 patients presenting with ischemic stroke, 58% were discharged home, 10% were discharged home with home care services, 15% were discharged to a rehabilitation hospital, 11% were discharged to a skilled or intermediate care facility, and 6% died. After adjusting for age, sex, race, and comorbidities, a significant association (P=.009) existed between discharge outcome and initial hematocrit level. The probability of achieving an equivalent or less favorable outcome increased at both high and low hematocrit levels, with a minimum probability at a hematocrit level of approximately 45%.

Conclusions:

An association exists between hematocrit level at the time of ischemic stroke and discharge outcome. Midrange hematocrit levels appear to be associated with discharge to home rather than to an inpatient rehabilitation unit or to a nursing facility. Further study is indicated to examine the relationship among hematocrit level, stroke severity, and outcome.

Section snippets

Patient sample

A total of 1012 patients with ischemic stroke (International Classification of Diseases, 9th Revision, Clinical Modifications [ICD-9-CM] codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, 436) admitted to the University of Virginia Health System between August 3, 1995, and June 24, 1999, were included in this study. Data on these patients were obtained from the Clinical Data Repository, a health system-wide database consisting of patient-level data assimilated from

Results

Our patient sample had a mean age of 68 years. Men represented 51% of the sample and women 49%. All but 7 of the patients were white (72%) or African American (28%). Frequent comorbid diagnoses included hypertension (65%) and diabetes (33%). More than 95% of patients had a hematocrit level recorded on their first day in the hospital. Twenty-three percent of patients had hematocrit levels that exceeded 45%; 2% had hematocrit levels below 30%. Median hematocrit level was 41.1%, with 25th and 75th

Discussion

Hematocrit level is the main determinant of both blood oxygen carrying capacity and blood viscosity.25 Early studies have shown that oxygen transport is reduced at low hematocrit levels because of low blood oxygen content.26 However, oxygen transport is also reduced at high hematocrit levels because of increased blood viscosity and slowed blood flow. Oxygen transport appears optimal at hematocrit levels of approximately 40%.26 These findings from earlier studies lend theoretical support to the

Conclusion

Midrange hematocrit levels were associated with discharge to home, whereas higher and lower hematocrit levels were associated with discharge to an inpatient rehabilitation unit or an SNF; no association was identified between hematocrit levels and hospital LOS, hospital charges, or mortality. Our preliminary findings suggest that hematocrit level at the time of ischemic stroke may have clinical relevance for outcome. Additional study is necessary to delineate more clearly the association

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    1

    Published as an abstract in Archives of Physical Medicine and Rehabilitation 2001;82:1343.

    2

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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