Abstract W MP105: Regionalization of Care and Increased Burden on Specialized Stroke Centers
Introduction: Many patients are transferred to specialized stroke centers for advanced ischemic stroke (AIS) care, especially after tPA. We sought to determine differences in the baseline characteristics and outcomes between AIS cases presenting directly to our academic stroke center as compared to those transferred from outside facilities (OSH).
Methods: Using our institutional GWTG stroke registry, we analyzed 1,726 AIS cases (01/09 - 02/14). Univariate and multivariable models explored differences in patients presenting directly at our center as compared to transferred from OSH.
Results: 46% percent of all AIS were transferred patients. Compared to those presenting directly at our center, transferred patients were older, more often Caucasian, with more vascular risk factors. They had worse median NIHSS, more often had limb weakness or aphasia and received IV tPA. In-hospital mortality was nearly double in transferred patients. Transfer-in patients had a longer hospital length of stay and were more often discharged to inpatient rehab. Independent predictors of in-hospital mortality were increasing age, A. fib, coronary artery disease and initial NIHSS. Transfer status was not independently associated with in-hospital mortality.
Conclusions: Transferred patients differed significantly from those presenting directly, they have more stroke risk factors and present with severe strokes. Accepting such patients increase the burden at specialized stroke centers. Despite having more severe strokes on arrival, transfer patients had similar in-hospital mortality after adjusting for stroke severity (NIHSS) lending support to the concept of regionalized stroke care.
Author Disclosures: N. Chauhan: None. S.F. Ali: None. A. Hinduja: None. D.M. Johnson: None. N. Bianchi: None.
- © 2015 by American Heart Association, Inc.