Comparing Outcomes of Transferred Versus Direct-Admit Ischemic Stroke Patients at a Large Comprehensive Stroke Center (P01.034)

Abstract

Objective: To evaluate the outcome of ischemic stroke (IS) patients, including sub acute IS and IV rt-PA patients transferred to a large Comprehensive Stroke Center (CSC), as compared to patients directly admitted through the CSC9s ED. Background Although many IS patients are transferred to Stroke Centers, particularly CSCs, it is unclear whether this is beneficial. Given the substantial resources required for transfer, an analysis of outcomes of these patients is important. Also, if transferred patients are significantly different from direct ED admits, this could influence performance metrics, which are increasingly being used by regulatory authorities 1 . Design/Methods: Retrospective study of all consecutively treated IS patients between 7/2006-12/2010 either through the CSC9s ED or transferred. Outcomes measures included admit and discharge NIHSS, mortality and length of stay (LOS). Results: From 7/2006-12/2010, 1305 IS patients were evaluated. 77% were ED admits and 23% transferred patients. Transferred patients were 51% female, younger (mean 67yr vs. 75yr for ED patients), and had more severe strokes with a mean admission NIHSS of 10 vs. 6 for direct admits (p=0.0001). Transferred patients showed greater functional improvement between admission and discharge NIHSS (difference between pre- and post-NIHSS 3.2 vs. 1.3 for direct admits, p=0.0001), but had longer LOS (6.9d vs. 4.5d for ED patients). Mortality risk was greater among transfers (OR 2.5 95% CI 1.6 – 3.9, p=0.0001). Conclusions: Despite having more severe strokes, transferred patients had greater improvement during hospitalization than directly admitted patients. However, transfers had substantially longer LOS and higher mortality despite being significantly younger. These data suggest important differences between transferred and non-transferred IS patients, which may have important implications for stroke center performance metrics. Nevertheless, these data support the transfer of stroke patients to tertiary centers or CSCs, given the overall improved outcomes. Supported by: