A Real-World Perspective on Interfacility Transfers of Acute Ischemic Stroke from a Semi-Rural Center

Abstract

Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with telestroke. Multiple linear regression for departure time from ED (DT), quantile regression for length of in-hospital stay (LOS), and Kaplan-Meier estimator with Cox proportional hazards model for one-year survival (SV) were performed. Results: 192 patients included were categorised according to IFT. Mechanical thrombectomy was performed in 50% who had been transferred. Differences were found in DT, discharge disposition and LOS. An inverse relationship existed between DT and NIHSS. The strongest predictor of LOS was TACS (β = 3.14 [0.03 - 8.49]; p = 0.005). SV was related to IFT (HR 4.68 [1.37 - 16.07]; p = 0.014), age (HR 1.1 [1.04 - 1.17]), BI < 60 (HR 2.7 [1.02 - 7.1]), TACS (HR 9.82 [1.08 - 88.95]) and NIHSS ≥ 6 (HR 2.85 [1.05 - 7.74]). Conclusions: Shared decision-making with a stroke unit through telemedicine enabled a standardised clinical management in a non-metropolitan setting. Several improvement opportunities were identified: multimodal computed tomography availability before transfer, as well as optimization of response time and training in neurosonology of emergency physicians.