Objective To assess the impact of interhospital transfer on the interplay between functional outcome, mortality, reperfusion rates and workflow time metrics in patients undergoing endovascular thrombectomy (EVT) for acute ischaemic stroke due to large vessel occlusion (LVO) in the anterior cerebral circulation. Design, setting and participants This is an analysis of a prospective database of consecutive patients undergoing EVT for LVO presenting between January 2017 and December 2018 at a single Australian comprehensive stroke centre (CSC). Patients presented directly or were transferred to the CSC from 21 sites across New South Wales and the Australian Capital Territory. Main outcome measures The main outcome measures were rate of good 90-day functional outcome (modified Rankin Scale 0–2), successful reperfusion (Thrombolysis in Cerebral Infarction scale grade 2b or 3), symptomatic intracerebral haemorrhage (sICH) and 90-day mortality. Key workflow time metric milestones were examined. Results 154 of 213 (72%) patients were interhospital transfers. There was no significant difference in baseline characteristics including age, National Institutes of Health Stroke Scale score, intravenous thrombolysis administration or procedure time between transferred and direct presenters (all p>0.05). Transferred patients had worse 90-day functional outcome (39.6% vs 61.0%, OR 0.42, 95% CI 0.23 to 0.78), higher mortality (25.3% vs 6.8%, OR 4.66, CI 1.59 to 13.70) and longer stroke onset to treatment (groin puncture) time (298 min vs 205 min, p<0.01). Successful reperfusion rates and sICH were similar between the cohorts (96.8% vs 98.3%, and 7.8% vs 3.4%). Conclusion Interhospital transfer is associated with longer stroke onset to treatment, worse 90-day functional outcome and higher mortality compared with patients presenting directly to the CSC.

中文翻译：

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澳大利亚医院间转运对接受血管内血栓切除术治疗急性缺血性卒中患者的影响

目的 评估院间转运对大脑前循环大血管闭塞 (LVO) 所致急性缺血性卒中患者接受血管内血栓切除术 (EVT) 的功能结果、死亡率、再灌注率和工作流程时间指标之间相互作用的影响。设计、设置和参与者 这是对 2017 年 1 月至 2018 年 12 月期间在单个澳大利亚综合卒中中心 (CSC) 接受 EVT 进行 LVO 的连续患者的前瞻性数据库的分析。患者直接就诊或从新南威尔士州和澳大利亚首都直辖区的 21 个地点转移到 CSC。主要结果测量 主要结果测量是 90 天功能结果良好率（改良 Rankin 量表 0-2），成功再灌注（脑梗死溶栓量表 2b 或 3 级）、症状性脑出血 (sICH) 和 90 天死亡率。检查了关键的工作流程时间指标里程碑。结果 213 名患者中有 154 名 (72%) 进行了医院间转运。基线特征包括年龄、美国国立卫生研究院卒中量表评分、静脉溶栓给药或转移和直接介绍者之间的手术时间没有显着差异（所有 p>0.05）。转移患者的 90 天功能结果更差（39.6% 对 61.0%，OR 0.42，95% CI 0.23 至 0.78），死亡率更高（25.3% 对 6.8%，OR 4.66，CI 1.59 至 13.70）和更长的卒中发作至治疗（腹股沟穿刺）时间（298 分钟对 205 分钟，p<0.01）。队列之间的成功再灌注率和 sICH 相似（96.8% vs 98.3%，和 7.8% 对 3.4%）。结论与直接就诊于 CSC 的患者相比，医院间转移与更长的卒中发病时间、更差的 90 天功能结果和更高的死亡率相关。