Return to primary service among bone marrow transplant rehabilitation inpatients: an index for predicting outcomes

Arch Phys Med Rehabil. 2013 Feb;94(2):356-61. doi: 10.1016/j.apmr.2012.08.219. Epub 2012 Sep 25.

Abstract

Objective: To assess rehabilitation inpatient risk of return to primary (RTP) service in patients with bone marrow transplant (BMT).

Design: Retrospective review.

Setting: Inpatient rehabilitation unit within a tertiary referral-based cancer center.

Participants: All patients with BMT (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010.

Interventions: None.

Main outcome measures: We analyzed RTP service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values.

Results: A total of 61 (41%) of 147 of BMT admissions were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 23 (38%) of 61 died after being transferred back to the primary service. Significant or near-significant relationships were found for a platelet count of <43,000 per microliter (P<.01); a creatinine level of >0.9 milligrams/deciliter (P<.01); the presence of an antiviral agent (P=.0501); the presence of an antibacterial agent (P=.0519); the presence of an antifungal agent (P<.05); and leukemia, lymphoma, or multiple myeloma diagnosis (P<.05). Using 5 of these factors, the RTP-BMT index was formulated to determine the likelihood of return to the primary team.

Conclusions: Patients with BMT have a high rate of transfer from the inpatient rehabilitation unit back to the primary service. The RTP-BMT index score can be a useful tool to help clinicians predict the likelihood of return to the primary acute care service.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Antifungal Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Bone Marrow Transplantation / rehabilitation*
  • Cancer Care Facilities
  • Creatinine / analysis
  • Female
  • Hospital Units
  • Hospitalization
  • Humans
  • Intensive Care Units*
  • Leukemia / epidemiology
  • Logistic Models
  • Lymphoma / epidemiology
  • Male
  • Middle Aged
  • Multiple Myeloma / epidemiology
  • Patient Transfer*
  • Platelet Count
  • Retrospective Studies
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Antifungal Agents
  • Antiviral Agents
  • Creatinine