Abstract WMP84: Transferring Patients with Intracerebral Hemorrhages to Tertiary Stroke Centers
Background: As a tertiary stroke center, we have increased outreach efforts to hospitals in the greater metropolitan region, having a policy to accept all patients with ICH. Comprehensive Stroke Center guidelines mandate receipt of these patients for higher level of care. We assessed the demographics, clinical severity, resource utilization, and proportion of eligibility for clinical trials among transferred patients compared to those directly arriving to our center. With an "open door" policy, we hypothesized that patients accepted from outside hospitals have more severe deficits and worse outcomes than those arriving directly to our center.
Methods: From our prospectively-collected stroke registry, we reviewed all spontaneous, primary ICH patients from 3/11-3/12. Primary outcome was the proportion of patients with mRS 4-6.
Results: Among 362 patients, 210 (58%) were transfers. Transferred patients were older (p<0.01), had higher median GCS (p=0.02), and lower NIHSS (p<0.01) than directly-admitted patients (table). Transfers had smaller median ICH volumes (p=0.04), lower ICH scores (p<0.01), and shorter time spent in ICU (p=0.02). Fewer transfers were enrolled in an investigational treatment trial (p<0.01). After adjusting for age, NIHSS, length of stay, ICH volume, presence of IVH, and history of CAD/MI, there was no difference in mRS 4-6 between the groups.
Conclusions: Contrary to our expectation, transferred patients had more favorable ICH characteristics with similar outcomes compared to directly admitted patients. Transferred patients required significantly fewer surgical procedures and a significant number of patients had very small hemorrhages and/or did not have IVH, excluding them from clinical trials. Over half arrived >24 hrs or had unknown onset. Our results raise the need to analyze cost-benefits and resource utilization of transferring patients with milder ICH.
- © 2012 by American Heart Association, Inc.