1236. The Impact of Inter-hospital Transfers versus Direct Admissions on Subarachnoid Hemorrhage Patients

Authors: Julianne Kleitsch; Julianne Kleitsch, BA; Dominic Nistal, BA; Christopher Kellner, MD; Cappi Lay; Hazem Shoirah; Johanna Fifi, MD; J Mocco, MD; Joshua Bederson, MD; Neha Dangayach (New York, NY)

Introduction:

Treatment of SAH at high-volume hospitals is associated with better outcomes, however inter-hospital transfer of patients to high-volume hospitals could delay treatment and lead to worse outcomes. With the increasing number of large healthcare systems, many hospitals are utilizing a centralized inter-hospital transfer system to perform diagnostic angiograms and endovascular treatment. In this study we look at patients who were diagnosed with SAH and either transferred or directly admitted to a comprehensive stroke center.

Methods:

One hundred thirty-seven patients diagnosed with SAH who underwent angiography from January 2017 through September 2018 were retrospectively reviewed. The patients were then classified into two groups: inter-hospital transfer and direct admission. Primary outcome was hospital length of stay and secondary outcomes included NSICU length of stay, Hunt Hess scores, morbidity, and mortality. Analyses were performed using Mann-Whitney U and ANOVA.

Results:

Of 137 patients, 69.3% (n=95) were female, 59.1% (n=59.1%) received endovascular therapy, 82.5% (n=113) were transferred, and 17.5% (n=24) were direct admits. The percentage of patients found to have an aneurysm was 67.9% (n=93). The percentage of patients who presented with a Hunt Hess score of 1-5 were 22.0% (n=30), 35.0% (n=48),15.3% (n=21),13.9% (n=19) and12.4%(n=17) respectively. The hospital length of stay for transfer patients was 16.2 days compared to 16.0 days for directly admitted patients (p=0.67). The NSICU length of stay mean for transfer patients was 11.2 days compared to 10.9 days for directly admitted patients (p=0.98).

Conclusion:

In SAH-diagnosed patients who receive angiography or endovascular treatment, there does not appear to be a difference in ICU or hospital length of stay between transfer and directly admitted patients. Limitations include retrospectively collected data and a small number of direct admissions compared to transfer patients. A large prospective cohort study is needed to better elicit the effect of inter-hospital transfers on patient outcomes.