Return to Primary Service Among Bone Marrow Transplant Rehabilitation Inpatients: An Index for Predicting Outcomes

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. Archives of Physical Medicine and Rehabilitation 2013;94:356-61 (C) 2013 by the American Congress of Rehabilitation Medicine