Abstract T P243: Mortality Among Transferred Hemorrhagic Stroke Patients in United States: An Analysis From National Database

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Malik M Adil ◽  
Shyam Prabhakaran
Keyword(s):  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
Inpatient Rehabilitation ◽  
National Database ◽  
Stroke Patients ◽  
Discharge Outcomes ◽  
Hospital Transfer ◽  
Transferred Patients ◽  
Surgical Treatments ◽  
Acute Rehabilitation

Background: Hemorrhagic stroke patients may require inter-facility transfer for higher level of care. Limited data are available on outcome of transferred patients. Objective: To determine in-hospital mortality and discharge outcomes among transferred hemorrhagic stroke patients. Methods: Data from all patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of hemorrhagic stroke [intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)] were identified by ICD-9 codes (ICH: 431; SAH: 430). In separate models for ICH and SAH using logistic regression, the odds ratio (OR) and 95% confidence intervals (CI) for in-hospital mortality and good outcome (discharge home or inpatient rehabilitation) among transfer vs. non-transfers were estimated, after adjusting for potential confounders. Results: Of 290,395 patients with ICH, 48,749 (16.8%) arrived by inter-hospital transfer; for SAH, 25,726 (33%) of 78,156 were transfers. In-hospital mortality was lower among ICH transfers (21.2% vs. 23.2%; p=0.004). In adjusted analyses, in-hospital mortality was not significantly different (p=0.20) while discharge to home or inpatient rehabilitation was more likely among transferred ICH patients (OR 1.1, 95% CI 1.0-1.2, p=0.05). In-hospital mortality was lower for SAH transfers (17.4% vs. 22.9%, p<0.001) and remained significant in adjusted analyses (OR 0.7, 95% CI 0.6-0.8). Transferred SAH patients were also more likely to be discharged to home or inpatient rehabilitation (OR 1.2, 95% CI 1.1-1.4, p<0.001). Coiling and clipping procedures were significantly more common in SAH transferred patients while cerebral angiography, mechanical ventilation and gastrostomy were significantly higher in both ICH and SAH transfer patients. Conclusion: While ICH patients arriving by transfer have similar mortality as non-transfers, they are more likely to be discharged to home or acute rehabilitation. For SAH, transfer confers both mortality and outcome benefit. Definitive surgical treatments and aggressive medical supportive care at receiving hospitals may mediate the benefits of inter-hospital transfer in hemorrhagic stroke patients.

Abstract 145: Transferred Ischemic Stroke Patients Have Worse Outcomes After Endovascular Therapy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Malik M Adil ◽  
Shyam Prabhakaran
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Systems Of Care ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Transferred Patients ◽  
Stroke Systems Of Care

Background and Objective: Ischemic stroke (IS) patients may require inter-facility transfer for higher level of care. Endovascular treatment is the main indication for transfer. We aimed to compare patient characteristics and clinical outcomes amongst transferred vs. non-transferred IS patients who undergo endovascular therapy. Methods: Patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of IS were identified by ICD-9 codes (433, 434, 436 and 437.1). Mechanical embolectomy (ME) was identified using the ICD-9 procedure code 39.74 or DRG 543 and cerebral angiography (CA) day 0-1 by 88.41. Using logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) for intracerebral hemorrhage (ICH), in-hospital mortality, and good outcomes (discharge home or inpatient rehabilitation) among transfer vs. non-transfers, adjusting for potential confounders. Results: Of 116,382 patients with IS treated with ME or CA (7.0% of all patients with IS), 10.1% were performed in transferred patients. Atrial fibrillation and hyperlipidemia was significantly higher in IS transfers. In-hospital mortality was higher among IS transfers (9.0% vs. 3.7%; p<0.001) and discharge to home or inpatient rehabilitation was less likely among transferred IS patients (70.2% vs. 80.6%; p<0.001). ICH was higher among IS transfers (4.6% vs. 1.7%; p<0.001). After adjusting for age, gender, race, presence of hypertension, dyslipidemia, atrial fibrillation, renal failure, alcohol abuse, insurance status, and hospital teaching status, transferred patients had higher odds of ICH (OR 2.0, 95% CI 1.5-2.8, p<0.001)] and death (OR 2.0, 95% CI 1.6-2.4, p<0.001) and lower odds of discharge to home/rehabilitation (OR 0.5, 95% CI 0.4-0.7, p<0.001) . Conclusion: Endovascular treatment for acute ischemic stroke may be associated with worse outcomes among inter-hospital transfer patients compared to non-transfers. Organized stroke systems of care may need to consider pre-hospital strategies to increase direct referrals to comprehensive stroke centers and inter-hospital strategies to reduce delays to treatment.

Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012

2016 ◽  
Vol 43 (1-2) ◽  
pp. 43-53 ◽  
Author(s):  
Hajere J. Gatollari ◽  
Anna Colello ◽  
Bonnie Eisenberg ◽  
Ian Brissette ◽  
Jorge Luna ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
New York State ◽  
Hospital Level ◽  
Stroke Patients ◽  
Hospital Size ◽  
Teaching Status ◽  
Hospital Characteristics

Background: Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Hypothesis: Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. Methods and Results: We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Conclusions: Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC status on outcomes after ICH. For conditions with clear treatments such as ischemic stroke and SAH, being treated in a DSC improves outcomes, but this trend was not observed in those with strokes, in those who did not have clear treatment guidelines. Identifying hospital-level factors associated with ICH and SAH represents a means to identify and improve gaps in stroke systems of care.

Severe Disability After Stroke: Outcome After Inpatient Rehabilitation

1999 ◽  
Vol 13 (3) ◽  
pp. 199-203 ◽  
Author(s):  
John G. Schmidt ◽  
Jessie Drew-Cates ◽  
Mary L. Dombovy
Keyword(s):  
Functional Outcome ◽  
Hemorrhagic Stroke ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Efficiency Score ◽  
Poor Functional Outcome ◽  
Rehabilitation Unit ◽  
Home Setting ◽  
Severe Stroke ◽  
Acute Rehabilitation

Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.

Abstract WP238: Thrombolytic Use in Stroke Mimics via Telestroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Michael A Sperl ◽  
Aditi Gupta ◽  
Jayashree Ravichandran ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Rehabilitation Unit ◽  
Stroke Mimics ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Mimic ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Acute Rehabilitation

Background: It has been established that safety and outcomes of intravenous thrombolysis (IVT) to stroke patients via telestroke (TS) is similar to those presenting to stroke centers. Little is known on the accuracy of TS diagnosis among those receiving IVT. We sought to compare the rate of stroke mimic (SM) patients receiving IVT in our TS network to those who present to our comprehensive stroke center (CSC). Methods: Consecutive patients receiving IVT between August 2014 and June 2015 were identified at our CSC and TS network. The rates of SM patients in each cohort were calculated. Outcomes measured included rates of symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, and discharge to home or an acute rehabilitation unit (ARU). Results: During the study period, 132 patients (mean age 71±15 years, 49% women) receiving IVT were included in the analysis (75 CSC, 57 TS). Rates of SM patients receiving IVT were similar (CSC 12% vs TS 7%, p=0.39). One stroke patient developed sICH, and three other stroke patients experienced in-hospital mortality; neither outcome was found in the SM cohort. Discharge to home or ARU was similar between stroke (76.5%) and SM (76.9%) patients (p=1). Patients with SMs had significantly higher diagnoses of migraine (p=0.045) and psychiatric disorders (p=0.0002) compared to stroke patients. Conclusion: The rate of IVT among SM patients via TS is low and similar to those who present directly to a stroke center. Continued efforts should be made to further minimize IVT in SM patients despite the low rate of complications.

scholarly journals Functional Outcome of Ischemic and Hemorrhagic Stroke Patients After Inpatient Rehabilitation

Stroke ◽  
2003 ◽  
Vol 34 (12) ◽  
pp. 2861-2865 ◽  
Author(s):  
Stefano Paolucci ◽  
Gabriella Antonucci ◽  
Maria Grazia Grasso ◽  
Maura Bragoni ◽  
Paola Coiro ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Hemorrhagic Stroke ◽  
Inpatient Rehabilitation ◽  
Stroke Patients

No. 137 Functional Outcome of Ischemic and Hemorrhagic Stroke Patients After Inpatient Rehabilitation

PM&R ◽  
2014 ◽  
Vol 6 (8) ◽  
pp. S123-S124
Author(s):  
Maria Vazquez Guimaraens ◽  
Belen Maside Oliete ◽  
Veronica Rodriguez Lopez ◽  
Carmen Crespo Lopez
Keyword(s):  
Functional Outcome ◽  
Hemorrhagic Stroke ◽  
Inpatient Rehabilitation ◽  
Stroke Patients

Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke

2016 ◽  
Vol 9 (12) ◽  
pp. 1166-1172 ◽  
Author(s):  
Lorenzo Rinaldo ◽  
Waleed Brinjikji ◽  
Brandon A McCutcheon ◽  
Mohamad Bydon ◽  
Harry Cloft ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
National Database ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Revascularization ◽  
Hospital Transfer ◽  
Transferred Patients ◽  
Using Data

BackgroundPatients with an acute ischemic stroke (AIS) due to large vessel occlusion often require transfer to an endovascular center for treatment.ObjectiveTo assess the effect of hospital transfer on outcomes after endovascular revascularization.MethodsOutcomes of endovascular revascularization were compared between directly admitted and transferred patients using data from a national database and our own institution.Results118 institutions within the database reported outcomes of 8533 inpatient admissions for endovascular treatment of AIS. Mortality rate (14.9% vs 18.6%; p=0.049) and mortality index (1.1 vs 1.6; p=0.048) were significantly lower among directly admitted patients than among transferred patients. Within our institutional cohort of 140 patients who underwent endovascular therapy, directly admitted patients had a significantly faster time to revascularization than transferred patients (277.4 vs 420.4 min; p≤0.0001). Among transferred patients, an increasing distance of transferred hospital to our home institution was associated with an increasing risk of mortality (unit OR=1.26, 95% CI 1.07 to 1.54; p=0.0061).ConclusionsOutcomes of revascularization may improve with methods to identify patients with large vessel occlusion before hospital admission, thus increasing the likelihood of initial triage to a comprehensive stroke center for patients eligible for endovascular intervention.

Abstract 64: The Use of Oral Anticoagulation After Ischemic Stroke Increases, Users Have Fewer Recurrences, and Are Increasingly Likely to Survive. A Nationwide Study From Finland

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Atte Meretoja ◽  
Antti Malmivaara ◽  
Risto O Roine ◽  
Unto Hakkinen ◽  
Markku Kaste
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Oral Anticoagulation ◽  
Hemorrhagic Stroke ◽  
Case Fatality ◽  
Preventive Therapy ◽  
National Database ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Initial Hospitalization

Background and Purpose: Oral anticoagulation (OAC) is an effective secondary preventive therapy after atrial fibrillation related cardioembolic ischemic stroke. We explored the use of OAC after ischemic stroke in Finland, the country with the most rapidly aging population in Europe. Methods: Data from 1999 to 2010 were extracted from the PERFECT Stroke registry, a nationwide database of all incident stroke patients hospitalized in Finland. Purchase of warfarin, the only OAC available during the study period in Finland, was registered in all pharmacies in a national database. Recurrence was defined as re-hospitalization with new acute stroke diagnosis through an emergency department. Survival was tracked from the national death registry with 100% follow-up. Results: Among the 99,677 incident ischemic stroke cases over the study period, there were 24,327 cases surviving their initial hospitalization and using OAC for secondary prevention. This represented 24.4% of all ischemic stroke patients, increasing from 20.3% in 1999 to 26.7% in 2010. In these OAC users, 1-year recurrence rate of ischemic stroke decreased from 20.1% in 1999 to 12.5% in 2010, while 1-year hemorrhagic stroke rate remained unchanged at 0.4%. Increases in the secondary preventive use of blood pressure medications (from 83.5% to 92.7%), statins (from 32.8% to 73.5%), and a combination of these (from 28.2% to 69.0%) were observed from 1999 to 2010. One-year case-fatality of patients surviving to go home was 4.2% when no recurrences occurred. When secondary prevention failed, patients who experienced a new ischemic stroke had 11.3% likelihood of dying within a year, increasing to 42.0% after a hemorrhagic stroke. After adjusting for age, sex, and comorbidities with a logistic regression model, the odds of 1-year case-fatality decreased over time (OR 0.97; 95% CI 0.95-0.99 per year). Conclusion: As the population ages, the proportion of ischemic stroke patients that require oral anticoagulation increases, in our data from 20% to 27% over a period of 12 years. Secondary prevention of stroke in OAC users improved, which could be due to increased use of antihypertensives and statins, and reflected on survival. The risk of hemorrhagic stroke due to anticoagulation for ischemic stroke remains small.

scholarly journals Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marc-Antoine Sanchez ◽  
Albert Vuagnat ◽  
Olivier Grimaud ◽  
Emmanuelle Leray ◽  
Jean-Marc Philippe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Healthcare Facility ◽  
Mortality Rates ◽  
National Database ◽  
Icu Patients ◽  
Transfer Distance ◽  
Transferred Patients ◽  
The Impact

Abstract Background The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to. Method A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality. Results In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6–0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2–0.4, p < 0.0001 for transfer distance > 200 km). Mortality decreased overall over the 3-month study period. Conclusions Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients.

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