Abstract T P197: Early Improvement In NIHSS Is Common During Inter-hospital Transfer And Is Associated With Lower In-hospital Mortality

Abstract

Introduction: A significant number of patients are transferred from outside referral hospitals (OSH) to larger tertiary care centers for specialized care or post-tPA management. As efforts to risk adjust stroke mortality and patient outcomes increase, better understanding of early changes in stroke severity are needed, especially changes in stroke severity that occur during interhospital transfer. We evaluated the percentage of patients with significant early improvement after transfer and associated patient characteristics and outcomes. Method: Using our Get with the Guidelines-Stroke registry, we identified 302 acute ischemic stroke transfer patients with documented initial NIHSS at the OSH from 12/10 - 12/13. Patients with early improvement after interhospital transfer (≥ 4 points improvement in NIHSS between initial NIHSS at receiving hospital minus initial at OSH) were compared to those without (< 4 points improvement or worsening). Baseline clinical characteristics, tPA treatment and outcomes were compared with Chi-square test and student's t-test. Results: There were 76/302 (25.2%) patients with ≥ 4 points improvement in NIHSS. Compared to those without early improvement, those with early improvement were less likely to have history of hyperlipidemia and carotid stenosis, presented with altered level of consciousness less often, and had higher median initial NIHSS at OSH. They had substantially lower inhospital mortality (3.9% vs. 12.4%). Discussion: Early improvement in stroke severity during interhospital transfer is common, and is not confined to patients receiving thrombolysis. These early improvement patients have very low mortality, and it is substantially lower than in those without early improvement, despite higher initial NIHSS. This has important implications for assessing the safety and efficacy of drip and ship thrombolysis or other pre-transfer interventions. Further research is warranted.