Background and Purpose

Inter-hospital transfer for ischemic stroke is an essential part of stroke system of care. This study aimed to understand the national patterns and outcomes of ischemic stroke transfer.

Methods and Results

This retrospective study examined Medicare beneficiaries aged ≥65 years undergoing inter-hospital transfer for ischemic stroke in 2012. Cox proportional hazards model was used to compare 30-day and one-year mortality between transferred patients and direct admissions from the emergency department (ED admissions). Among 312,367 ischemic stroke admissions, 5.7% underwent inter-hospital transfer. Using this value as cut-off, the hospitals were classified into receiving (n = 411), sending (n = 559), and low-transfer (n = 1863) hospitals. Receiving hospitals were larger than low-transfer and sending hospitals as demonstrated by the median bed number (371, 189, and 88, respectively, p < 0.001); more frequently to be certified stroke centers (75%, 47%, and 16%, respectively, p < 0.001); and less commonly located in the rural area (2%, 7%, and 24%, respectively, p < 0.001). For receiving hospitals, transfer-in patients and ED admissions had comparable mortality at 30 days (10% vs 10%; adjusted HR [aHR]=1.07; 95% CI, 0.99–1.14) and 1 year (23% vs 24%; aHR=1.03; 95% CI, 0.99–1.08). For sending hospitals, transfer-out patients, compared to ED admissions, had higher mortality at 30 days (14% vs 11%; aHR=1.63; 95% CI, 1.39–1.91) and 1 year (30% vs 27%; aHR=1.33; 95% CI, 1.20–1.48). For low-transfer hospitals, overall transfer-in and transfer-out patients, compared to ED admissions, had higher mortality at 30 days (13% vs 10%; aHR=1.46; 95% CI, 1.33–1.60) and 1 year (28% vs 25%; aHR=1.27; 95% CI, 1.19–1.36).

Conclusions

Hospitals in the US, based on their transfer patterns, could be classified into 3 groups that shared distinct characteristics including hospital size, rural vs urban location, and stroke certification. Transferred patients at sending and low-transfer hospitals had worse outcomes than their ED admission counterpart.

中文翻译：

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Medicare缺血性卒中患者的医院间转移模式和结果

背景和目的

缺血性中风的医院间转移是中风护理系统的重要组成部分。这项研究旨在了解缺血性中风转移的国家模式和结果。

方法与结果

这项回顾性研究调查了2012年因缺血性卒中接受医院间转移的65岁以上的Medicare受益人。使用Cox比例风险模型比较了转移患者与急诊直接住院患者之间的30天和一年死亡率（ED入院） ）。在312,367例缺血性中风住院患者中，有5.7％进行了院际转移。使用该值作为截止值，将医院分为接收（n  = 411），发送（n  = 559）和低转移（n  = 1863）医院。如中位数床位所示（分别为371、189和88，p <0.001）; 获得认证的卒中中心的频率更高（分别为75％，47％和16％，p  <0.001）；且在农村地区较不常见（分别为2％，7％和24％，p <0.001）。对于入院医院，转入患者和ED住院患者在30天时的死亡率相当（10％比10％；调整后的HR [aHR] = 1.07； 95％CI，0.99-1.14）和1年（23％比24％； aHR = 1.03； 95％CI，0.99-1.08）。对于转诊医院，与ED入院相比，转出患者在30天时死亡率更高（14％vs 11％； aHR = 1.63； 95％CI，1.39–1.91）和1年时（30％vs 27％； aHR） = 1.33； 95％CI，1.20-1.48）。与急诊科住院病人相比，低流转医院的整体转入和转出患者在30天和1年内的死亡率更高（13％比10％； aHR = 1.46； 95％CI，1.33-1.60）。 28％和25％； aHR = 1.27； 95％CI，1.19–1.36）。

结论

根据转移模式，美国医院可分为3组，它们具有不同的特征，包括医院规模，农村与城市位置以及中风证明。转诊医院和低转诊医院的转诊患者比急诊就诊患者的转归差。