Abstract 2833: Transfers to Tertiary Care Hospitals Improve Outcome in Patients with Subarachnoid Hemorrhage but not Intracerebral Hemorrhage
Background: Patients with ischemic stroke are being increasingly transferred after initial evaluation at an outside hospital under the drip-and ship paradigm. However, the value of such practices for hemorrhagic strokes cannot be assessed due to limited data on proportion and outcomes of patients who are transferred from an outside hospital to a tertiary care center.
Objective: We sought to determine the proportion and outcomes of patients with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) who are transferred from outside hospital to a tertiary care center in United States
Methods: We analyzed patient data from the Nationwide Inpatient Sample, the largest all-payer inpatient care database in the United States, for the 2005-2008 years. All patients with primary diagnoses of SAH or ICH were identified using ICD-9 CM codes. For each diagnosis, baseline characteristics, hospital complications, and outcomes were compared between the patients admitted locally and patients transferred to tertiary hospitals using univariate and multivariate logistic regression.
Results: The absolute numbers and proportions of patients transferred to tertiary hospitals were 11806 (25.7%) and 14282 (10.5%) for SAH and ICH, respectively. In univariate analysis, transferred SAH patients were significantly more likely to be discharged home compared to those who were admitted locally (p<0.001) and had significantly lower in-hospital mortality rates (p<0.001); whereas in transferred ICH patients these outcomes did not differ significantly (p=0.05 and p=0.68, respectively). When adjusted for baseline differences, transfer between hospitals was associated with lower rates of in-hospital death among patients with SAH (OR=0.71 [95%CI =0.61-0.82], p<0.001), but did not effect in-hospital mortality among patients with ICH (OR=0.93 [95%CI =0.84-1.04], p=0.22). There was a non-significant trend in transfer between hospitals to be associated with higher rates of home discharges among patients with SAH (OR=1.11 [95%CI =0.97-1.28], p=0.07), while transfer between hospitals resulted in significantly lower rate of patients with ICH to be discharged home (OR=0.87 [95%CI =0.78-0.97], p=0.01)
Conclusion: Transfers to tertiary hospitals appears to be associated with better clinical outcomes in patients with SAH but not with ICH. Our results warrant a critical evaluation of transfer between hospitals in patients with ICH.
- © 2012 by American Heart Association, Inc.