Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

US Trends in Interhospital Transfers, Thrombectomy

J Stroke Cerebrovasc Dis; ePub 2019 Jan 9; George, et al

From 2009 to 2014, interhospital stroke transfers to endovascular-capable hospitals increased by one-third, according to a recent study. Furthermore, for every 15 additional transfers over the time period, 1 additional patient received thrombectomy. Therefore, optimization of transfers presents an opportunity to increase access to thrombectomy. Using a stratified survey design of the US Nationwide Inpatient Sample (2009-2014), researchers examined trends in interhospital transfers for ischemic stroke resulting in mechanical thrombectomy. They found:

  • From 2009-2014, 772,437 ischemic stroke admissions were identified.
  • Stroke admissions that arrived via interhospital transfer increased from 12.5% to 16.8%, 2009-2014.
  • Transfers receiving thrombectomy increased from 4.0% to 5.2%, 2009-2014, while those receiving tissue plasminogen activator increased from 16.0% to 20.0%, 2009-2014.
  • 1 in 4 patients receiving thrombectomy were transferred from another acute care facility (n=6,014 of 24,861).
  • Compared to patients arriving via the hospital “front door” receiving mechanical thrombectomy, those arriving via transfer were more often from rural areas and received by teaching hospitals with greater frequency of thrombectomy.
  • Those arriving via interhospital transfer undergoing thrombectomy had greater odds of symptomatic intracranial hemorrhage vs “front door” arrivals.
  • There were no differences in inpatient mortality.

George BP, Pieters TA, Zammit CG, Kelly AG, Sheth KN, Bhalla T. Trends in interhospital transfers and mechanical thrombectomy for United States acute ischemic stroke inpatients. [Published online ahead of print January 9, 2019]. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2018.12.018.