Delay in transfer to inpatient stroke rehabilitation: The role of acute hospital medical complications and stroke characteristics

Background: An increased delay between stroke onset and transfer to rehabilitation has been associated with poorer outcomes after stroke rehabilitation. Purpose: The purpose of this study was to examine the relationships between selected clinical factors and the interval from stroke onset to rehabilitation admission. Method: A cohort of 2,457 patients consecutively admitted for inpatient stroke rehabilitation was studied. Patient demographic data, stroke characteristics, stroke onset to rehabilitation admission interval (ORAI), and medical complications that occurred during the acute post-stroke hospitalization were documented. Univariate and multiple regression analyses were used to determine relationships between patient demographic data, stroke characteristics, and acute medical complications with ORAI. Results: The average ORAI was 17.2 days, with a median of 12 days. Stroke characteristics and acute medical complications were the two groups of factors that were most strongly associated with longer ORAIs. These two groups each explained approximately 15.5% and 17.3% of the variance in the model, respectively. The most significant individual factors included the presence of an enteral feeding tube, a hemorrhagic stroke, a cortical stroke, pneumonia, urinary tract infection, and younger age at stroke onset. Conclusion: Although some medical problems associated with longer ORAI are functions of the severity of the stroke and patient characteristics, attention to preventable medical complications may be associated with a more rapid transition to the inpatient rehabilitation setting.