Abstract Details

Title Characteristics and Outcomes among Acute Ischemic Stroke Patients Arriving to the Hospital Via the "Front Door" vs. Transfer from Another Acute Care Hospital

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) IN7 - (-)

Poster/Presentation
Number 003

Objective

Background Many patients are transferred to academic stroke centers for advanced AIS care, especially after IV tPA, we determined the differences between the two cohorts.

Design/Methods Using our Get with the Guidelines-Stroke registry, we analyzed 1832 consecutively admitted AIS cases (01/09 - 06/12). Univariate and multivariable models explored differences in front door vs. transfer-in patients.

Results 875/1832 (52%) of cases were transfers-in. Compared to front door patients, transfers-in were more likely to be younger (67.2 ± 15.4 vs. 70.8 ± 15.5; p<0.001) have greater median initial NIHSS (7.0 vs. 3.0; p<0.001), more often limb weakness (63% vs. 57%; p=0.02) and aphasia (30% vs. 22%; p<0.001) and receive IV tPA (33% vs. 16%; p<0.001). Despite these differences, in-hospital mortality was similar (13% vs. 11%; p=0.35) between the two groups. Transfer-in patients had a longer hospital length of stay (6.0 ± 6.2 d vs. 4.7 ± 5.2 d; p<0.001) and survivors were more likely to be discharged to inpatient rehabilitation facilities (48% vs. 34%; p<0.001). Independent predictors of in-hospital mortality among all 1832 patients were increasing age [OR 1.03 per yr (95% CI 1.02 - 1.05); p<0.001], history of atrial fibrillation [OR 1.53 (95% CI 1.06 - 2.23); p=0.03], and higher initial NIHSS [1.19/point (95% CI 1.16 - 1.22); p<0.001]. Mode of presentation (front door vs. transfer-in) was not associated with in-hospital mortality.

Conclusions Transfers of care to our stroke center were common, and these patients were more severely disabled on arrival. Despite this, transfer-in patients had similar in-hospital mortality and increased frequency of discharge to rehabilitation centers. These outcomes support the concept of regionalized stroke care and concentrating sicker patients at more advanced centers.

Authors/Disclosures
Syed T. Ali, MBBS, BSc, MD (Syed T Ali MD PLLC) PRESENTER	No disclosure on file
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital)	An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (��ɫ��) with Biogen.
Mark S. Freedman, MD, FAAN (University of Ottawa)	Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Actelion(Janssen/J&J). Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BiogenIdec. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS/Celgene. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Inc. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion (Janssen/J&J). Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Atara Biotherapeutics. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer Healthcare. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BiogenIdec. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Clene Nanomedicine. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GRI Bio. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Magenta Therapeutics. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Freedman has received research support from Sanofi Genzyme.
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital)	Dr. Rost has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for ��ɫ��. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System)	Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime ��ɫ��. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.

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