Incidence of and risk factors for medical complications during stroke rehabilitation

Background and Purpose-The aims of this study were to examine the frequency , types, and clinical factors associated with medical complications that oc cur during inpatient rehabilitation and to identify risk factors for compli cations that require a transfer to an acute care facility. Methods-A cohort of 1029 patients consecutively admitted for inpatient stro ke rehabilitation was studied. Demographic and stroke information, impairme nt, preexisting medical conditions, and admission laboratory abnormalities were recorded. Medical complications, defined as new or exacerbated medical problems, were documented for each patient. Complications that required tr ansfer off rehabilitation were noted. Univariate and multiple logistic regr ession analyses were used to determine factors that were associated with ri sk of medical complications and risk of transfer off rehabilitation. Results-Seventy-five percent of patients experienced greater than or equal to1 medical complication during rehabilitation. Significant factors for the development of any medical complication included greater neurological defi cit (odds ratio [OR], 4.10; confidence interval [CT], 1.88 to 8.91), hypoal buminemia (OR, 1.71; 95% CI, 1.15 to 2.52), and history of hypertension (OR , 1.81; 95% CI, 1.27 to 2.59). Nineteen percent of patients had a medical c omplication that required transfer to an acute care facility. Significant f actors for transfers were elevated admission white blood cell counts (OR, 1 .92; 95% CI, 1.32 to 2.79), low admission hemoglobin levels (OR, 1.89; 95% CI, 1.32 to 2.68), greater neurological deficit (OR, 2.46; 95% CI, 1.37 to 4.39), and a history of cardiac arrhythmia (OR, 1.79; 95% CI, 1.18 to 2.67) . Conclusions-Medical complications are common among patients undergoing stro ke rehabilitation. A significant number of these medical complications may require a transfer to an acute facility.