Transferring Patients with Intracerebral Hemorrhage Does Not Increase In-Hospital Mortality.
PLoS One
; 11(7): e0159174, 2016.
Article
in En
| MEDLINE
| ID: mdl-27467594
ABSTRACT
INTRODUCTION:
Comprehensive stroke centers (CSCs) accept transferred patients from referring hospitals in a given regional area. The transfer process itself has not been studied as a potential factor that may impact outcome. We compared in-hospital mortality and severe disability or death at CSCs between transferred and directly admitted intracerebral hemorrhage (ICH) patients of matched severity. MATERIALS ANDMETHODS:
We retrospectively reviewed all primary ICH patients from a prospectively-collected stroke registry and electronic medical records, at two tertiary care sites. Patients meeting inclusion criteria were divided into two groups patients transferred in for a higher level of care and direct presenters. We used propensity scores (PS) to match 175 transfer patients to 175 direct presenters. These patients were taken from a pool of 530 eligible patients, 291 (54.9%) of whom were transferred in for a higher level of care. Severe disability or death was defined as a modified Rankin Scale (mRS) sore of 4-6. Mortality and morbidity were compared between the 2 groups using Pearson chi-squared test and Student t test. We fit logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI) for association between transfer status and in-hospital mortality and severe disability or death in full and PS-matched patients.RESULTS:
There were no significant differences in the PS-matched transfer and direct presentation groups. Patients transferred to a regional center were not at higher odds of in-hospital mortality (OR 0.93, 95% CI 0.50-1.71) and severe disability or death (OR 0.77, 95% CI 0.39-1.50), than direct presenters, even after adjustment for PS, age, baseline NIHSS score, and glucose on admission.CONCLUSION:
Our observation suggests that transfer patients of similar disease burden are not at higher risk of in-hospital mortality than direct presenters.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cerebral Hemorrhage
/
Patient Transfer
/
Hospital Mortality
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
PLoS One
Journal subject:
CIENCIA
/
MEDICINA
Year:
2016
Document type:
Article
Affiliation country:
United States