Risk factors for 30-day readmission in patients with ischemic stroke: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: The aim of this study was to identify risk factors for 30-day readmission in ischemic stroke survivors, with an attempt to improve post-discharge care and lower the 30-day readmission rate. METHODS: Seven databases were searched from inception to April 30, 2021. Retrospective or prospective observational studies and interventional studies focusing on 30-day readmission risk factors in patients with ischemic stroke were included. Two authors independently screened the literature and evaluated the quality of the studies using the Newcastle-Ottawa scale (NOS). The pooled effect size was estimated using the odds ratio (OR), and the corresponding 95% confidence interval (CI) was calculated. The Cochrane Q (χ2) and I2 tests were used to assess heterogeneity among studies, and each risk factor was tested for its robustness using fixed- or random-effects models. RESULTS: A total of 17 retrospective observational studies from the United States (n=10), China (n=2), Republic of Korea (n=2), Norway (n=2), and Australia (n=1), comprising a total of 1,829,964 patients, were included. The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64%, with a mean value of 10.66%±6.87%. We finally identified 6 risk factors: history of stroke (OR, 1.33; 95% CI: 1.08-1.64; P=0.007), diabetes mellitus (OR, 1.15; 95% CI: 1.13-1.17; P<0.001), hypertension (OR, 1.10; 95% CI: 1.07-1.13; P<0.001), atrial fibrillation (OR, 1.26; 95% CI: 1.23-1.29; P<0.001), heart failure (OR, 1.59; 95% CI: 1.56-1.63; P<0.001), and age, among which age was determined by descriptive analysis. Four risk factors were ruled out: hyperlipidemia (OR, 1.01; 95% CI: 0.87-1.17; P=0.91), coronary artery disease (OR, 0.83; 95% CI: 0.73-0.96; P=0.009), smoking (OR, 0.97; 95% CI: 0.83-1.14; P=0.71), and gender (female, OR, 0.97; 95% CI: 0.96-0.98; P<0.001). DISCUSSION: The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64% and remained challenging. We found that stroke history, diabetes mellitus, hypertension, atrial fibrillation, heart failure, and advanced age were risk factors for 30-day readmission, whereas hyperlipidemia, coronary artery disease, smoking, and gender were not. All the studies included in this analysis were case-control studies, and thus causality cannot be inferred. Furthermore, recall bias may be present.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.018 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".