ESTIMATING TOTAL BARTHEL SCORES FROM JUST 3 ITEMS - THE EUROPEAN STROKE DATABASE MINIMUM DATASET FOR ASSESSING FUNCTIONAL STATUS AT DISCHARGE FROM HOSPITAL

Background: the European Stroke Database (ESDB) Project aims to develo p a 'common clinical language' for stroke care by agreeing on terminol ogy, definitions and clinical assessments. Each area of stroke assessm ent has a 'minimum dataset', which can be collected routinely and more detailed information can be added for particular studies, Measurement of patients' functional status at discharge is essential for assessin g the impact of hospital care, but even simple activities of daily liv ing scales like the Barthel index may not be easy to use routinely on busy acute units. We thus aimed to further simplify the 20-point Barth el index by reducing it to a few key items. Methods: we initially anal ysed data on 169 consecutive stroke patients discharged from one Briti sh hospital and found that a simple formula involving the combined sub scores for urinary continence (Blad), bed-chair transfers (Trans) and indoor mobility (Mob)-(Blad + Trans + Mob) x 2.39 + 0.14-predicted the total BI score to within 1 point in 79% and to within 2 points in 95% of cases. We then tested this three-item Barthel index (BI3) in four different stroke datasets (total n = 824). Results: the predictions we re accurate to +/-1 point in 72-81% and to +/-2 points in 88-97% of ca ses, and BI3 accounted for 95% of the variance in total Barthel score. It was more accurate in patients without obvious mental impairment. C onclusions: for studies involving large groups of stroke patients, it is sufficient to know about each patient's continence, transfers and i ndoor mobility at discharge, in order to estimate the total Barthel sc ore. These measures have therefore been incorporated, together with a simple observational measure of cognitive status, into the database mi nimum dataset for short-term functional outcome and are now being vali dated in international studies.