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

ObjectiveTo assess rehabilitation inpatient risk of return to primary (RTP) service in patients with bone marrow transplant (BMT).DesignRetrospective review.SettingInpatient rehabilitation unit within a tertiary referral-based cancer center.ParticipantsAll patients with BMT (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010.InterventionsNone.Main Outcome MeasuresWe analyzed RTP service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values.ResultsA 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.ConclusionsPatients 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.