Abstract 145: Transferred Ischemic Stroke Patients Have Worse Outcomes After Endovascular Therapy
Background and Objective: Ischemic stroke (IS) patients may require inter-facility transfer for higher level of care. Endovascular treatment is the main indication for transfer. We aimed to compare patient characteristics and clinical outcomes amongst transferred vs. non-transferred IS patients who undergo endovascular therapy.
Methods: Patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of IS were identified by ICD-9 codes (433, 434, 436 and 437.1). Mechanical embolectomy (ME) was identified using the ICD-9 procedure code 39.74 or DRG 543 and cerebral angiography (CA) day 0-1 by 88.41. Using logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) for intracerebral hemorrhage (ICH), in-hospital mortality, and good outcomes (discharge home or inpatient rehabilitation) among transfer vs. non-transfers, adjusting for potential confounders.
Results: Of 116,382 patients with IS treated with ME or CA (7.0% of all patients with IS), 10.1% were performed in transferred patients. Atrial fibrillation and hyperlipidemia was significantly higher in IS transfers. In-hospital mortality was higher among IS transfers (9.0% vs. 3.7%; p<0.001) and discharge to home or inpatient rehabilitation was less likely among transferred IS patients (70.2% vs. 80.6%; p<0.001). ICH was higher among IS transfers (4.6% vs. 1.7%; p<0.001). After adjusting for age, gender, race, presence of hypertension, dyslipidemia, atrial fibrillation, renal failure, alcohol abuse, insurance status, and hospital teaching status, transferred patients had higher odds of ICH (OR 2.0, 95% CI 1.5-2.8, p<0.001)] and death (OR 2.0, 95% CI 1.6-2.4, p<0.001) and lower odds of discharge to home/rehabilitation (OR 0.5, 95% CI 0.4-0.7, p<0.001) .
Conclusion: Endovascular treatment for acute ischemic stroke may be associated with worse outcomes among inter-hospital transfer patients compared to non-transfers. Organized stroke systems of care may need to consider pre-hospital strategies to increase direct referrals to comprehensive stroke centers and inter-hospital strategies to reduce delays to treatment.
Author Disclosures: M.M. Adil: None. S. Prabhakaran: None.
- © 2014 by American Heart Association, Inc.