Abstract TP78: When Non-revascularized Transfer Patients Come A-Knocking at a Stroke Center

Abstract

Background: Guidelines recommend acute ischemic stroke (AIS) patients be transported rapidly to the closest certified stroke center (SC). The impact of SC care on transfer patients who do not receive acute revascularization therapy is not well understood. We sought to compare patient characteristics, adverse events (AEs), and short term functional outcomes in patients directly presenting to and transferred into a comprehensive stroke center (CSC). Methods: We conducted a retrospective review of consecutive AIS patients transferred to our CSC from March 2014-April 2015. We excluded patients who received tPA or endovascular therapy. Demographic and clinical data were collected. We compared AEs (hemorrhagic transformation [HT], DVT, PE, urinary tract infection [UTI], pneumonia [PNA], bacteremia) and poor short term functional outcome, as defined by modified Rankin scale (mRS) score 3-6, among patients directly admitted to our CSC and patients transferred to our CSC. Results: Of 589 patients who did not receive revascularization therapy, 24.4% were transfers. Transfers were disproportionately white (76.4 vs 57.8%, p<0.001), had higher median NIHSS (5 vs 4, p=0.028), were less often privately insured (40.1 vs 46.4%), and had less desirable ASPECTS scores on initial head CT (8-10; 22.9 vs 44.0, p<0.001). Transfers had higher odds of having AEs (crude OR 2.134, 95% 1.353-3.365). This association remained after adjusting for age, stroke severity, and admission glucose (OR 2.103, 95% CI 1.276-3.466.004). Transfers more frequently developed HT on repeat imaging (17.5 vs 7.0%, p<0.001), clinical seizure during inpatient stay (4.9 vs 1.6%, p=0.024), and PNA (7.6 vs 3.8%, p=0.061). However, transfer status was not associated with poor short-term functional outcome (crude OR 1.453, 95% CI 0.986-2.141; adjusted OR 1.200, 95% CI 0.703-2.046). Conclusion: Despite having more severe strokes and higher frequency of adverse events, patients transferred into our CSC for a higher level of care did not have worse short term functional outcomes. This highlights the importance of specialized inpatient care provided in NICUs and stroke units by experienced multidisciplinary teams.