J Korean Neurol Assoc.  2019 May;37(2):150-155. 10.17340/jkna.2019.2.5.

Current Status of Interhospital Transfer in Acute Ischemic Stroke

• Hur W
• Ha SW
• Kang HG

• KMID: 2454840
• DOI: http://doi.org/10.17340/jkna.2019.2.5

Abstract

BACKGROUND
Selecting the appropriate patients and reducing stroke onset to endovascular recanalization therapy (ERT) time are essential elements of a successful ERT. Since ERT is available only in large hospitals, proper patients transfer is important. The purpose of study is to examine the suitability of the transfer of acute stroke patients.
METHODS
We retrospectively reviewed the medical records of patients who diagnosed as acute ischemic stroke from January to December in 2017. Patients were divided into two groups based on transfer (direct visit vs. transfer) and Alberta Stroke Program Early computed tomography (ASPECT) score (≥8 vs. <8) respectively. Each group was assessed by demographics, type and rate of reperfusion therapy, onset to reperfusion therapy time, stroke risk factors and neurological deficit severity. Interhospital distance and transfer time was calculated in transferred patients.
RESULTS
Among the 455 patients, the 228 (50.2%) patients underwent interhospital transfer. The ratio of reperfusion therapy was not significant different between direct visit and transferred group (34.8% vs. 37.3%, p=0.397). The transferred patients tended to be older (p=0.003), female (p=0.001), more hypertension (p=0.019), less transient ischemic attack (p=0.001), longer onset to ERT time (178.55±85.92 vs. 131.48±82.89; p=0.001) lower ASPECT score (6.72±2.04 vs. 8.01±1.65; p<0.001) and higher National Institute of Health Stroke Scale (NIHSS) (p<0.001) and modified Rankin Scale (mRS) (p<0.001). High ASPECT score (≥8) patients were more direct visited (63.9%), shorter onset to ERT time (p=0.047), lower initial NIHSS and mRS (p<0.001), and greater in differences between mRS at admission and 3 months later (p=0.016).
CONCLUSIONS
This study suggests emergency and interhospital transfer of acute stroke patients is inefficient, and systematization of transfer is necessary.

Keyword

Endovascular procedures; Neuroimaging; Patient transfer; Stroke

MeSH Terms

Alberta
Demography
Emergencies
Endovascular Procedures
Female
Humans
Hypertension
Ischemic Attack, Transient
Medical Records
Neuroimaging
Patient Transfer
Reperfusion
Retrospective Studies
Risk Factors
Stroke*