Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study
Received 13 January 2020
Accepted for publication 5 May 2020
Published 16 June 2020 Volume 2020:12 Pages 617—624
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Vera Ehrenstein
Sheng-Feng Sung,1,* Chien-Chou Su,2– 4,* Cheng-Yang Hsieh,2,3,5 Ching-Lan Cheng,2– 4,6 Chih-Hung Chen,7 Huey-Juan Lin,8 Yu-Wei Chen,9,10 Yea-Huei Kao Yang2– 4,6
1Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan; 2Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan; 5Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; 6School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Neurology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan; 8Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan; 9Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan; 10Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
*These authors contributed equally to this work
Correspondence: Yea-Huei Kao Yang
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Tel +886-6-2353535 ext.5688
Purpose: Home-time has been found to correlate well with modified Rankin Scale (mRS) scores in patients with stroke. This study aimed to determine its correlations in patients with different types of stroke at various time points after stroke in a non-Western population.
Methods: This study used linked data from multi-center stroke registry databases and a nationwide claims database of health insurance. Functional outcomes as measured with the modified Rankin Scale were obtained from the registry databases and home-time was derived from the claims database. Spearman correlation coefficients were used to assess the correlation between home-time and mRS scores. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of home-time in predicting good functional outcome.
Results: This study included 7959 patients hospitalized for stroke or transient ischemic attack (TIA), for whom mRS scores were available in 6809, 6694, and 4330 patients at 90, 180, and 365 days, respectively. Home-time was highly correlated with mRS scores at the three time-points in patients with ischemic (Spearman’s rho − 0.69 to − 0.83) or hemorrhagic (Spearman’s rho − 0.86 to − 0.88) stroke, but the correlation was only weak to moderate in those with TIA (Spearman’s rho − 0.32 to − 0.58). Home-time predicted good functional outcome with excellent discrimination in patients with ischemic (AUCs > 0.8) or hemorrhagic (AUCs > 0.9) stroke but less so in those with TIA (AUCs > 0.7).
Conclusion: Home-time was highly correlated with mRS scores and showed excellent discrimination in predicting good functional outcome in patients with ischemic or hemorrhagic stroke. Home-time could serve as a valid surrogate measure for functional outcome after stroke.
Keywords: home-time, stroke, disability
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