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Ischemic stroke
Original research
Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke
  1. Lorenzo Rinaldo1,
  2. Waleed Brinjikji2,
  3. Brandon A McCutcheon1,
  4. Mohamad Bydon1,
  5. Harry Cloft1,2,3,
  6. David F Kallmes1,2,3,
  7. Alejandro A Rabinstein1,4
  1. 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Alejandro A Rabinstein, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA; rabinstein.alejandro{at}mayo.edu

Abstract

Background Patients with an acute ischemic stroke (AIS) due to large vessel occlusion often require transfer to an endovascular center for treatment.

Objective To assess the effect of hospital transfer on outcomes after endovascular revascularization.

Methods Outcomes of endovascular revascularization were compared between directly admitted and transferred patients using data from a national database and our own institution.

Results 118 institutions within the database reported outcomes of 8533 inpatient admissions for endovascular treatment of AIS. Mortality rate (14.9% vs 18.6%; p=0.049) and mortality index (1.1 vs 1.6; p=0.048) were significantly lower among directly admitted patients than among transferred patients. Within our institutional cohort of 140 patients who underwent endovascular therapy, directly admitted patients had a significantly faster time to revascularization than transferred patients (277.4 vs 420.4 min; p≤0.0001). Among transferred patients, an increasing distance of transferred hospital to our home institution was associated with an increasing risk of mortality (unit OR=1.26, 95% CI 1.07 to 1.54; p=0.0061).

Conclusions Outcomes of revascularization may improve with methods to identify patients with large vessel occlusion before hospital admission, thus increasing the likelihood of initial triage to a comprehensive stroke center for patients eligible for endovascular intervention.

  • Embolic
  • Intervention
  • Stroke

https://doi.org/10.1136/neurintsurg-2016-012824

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    Footnotes

    • Contributors LR: study design, data collection, statistical analysis, drafting of manuscript, critical revision; WB, AAR: study design, critical revision; BAM: statistical analysis, critical revision; MB, HC, DFK: critical revision. 

    • Competing interests None declared.

    • Ethics approval Institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data used for this article were obtained partially from a national database; these data are available to members. Data from our institution are available to the authors only.