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Background: Acute ischemic stroke (AIS) patients presenting to community hospitals may frequently be transferred to stroke centers if appropriate resources are not available at the referring facilities. Many patients may require discharge to acute rehabilitation (ARF) or skilled nursing (SNF) facilities prior to returning to home. We hypothesize that patients transferring to our comprehensive stroke center (CSC) who require discharge to either ARF or SNF may have longer lengths of stay (LOS) as compared to those who directly present to our CSC.Methods: From September 2015 to December 2016, LOS (days) of AIS patients admitted to our CSC who were discharged to either an ARF or SNF were examined. Patients were compared based on method of presentation (direct versus transfer).Results: During the study period, a total of 259 patients (75.1±14.1 years, 50.6% female) were examined (181 direct, 78 transfer). Mean distance of transferring facilities to our CSC was 112.3±87.3 miles. There were 154 patients (99 direct, 55 transfer) discharged to ARF, and 105 patients (82 direct, 23 transfer) were discharged to SNF. Transferred-in patients discharged to ARF had significantly longer LOS when compared to direct presentation patients discharged to ARF (6.1±3.5 vs 3.9±2.4, p<0.0001). However, no such significant difference was noted for discharges to SNF (5.3±2.8 transfer vs 7.9±15.9 direct, p=0.58).Conclusion: While LOS for patients discharged to SNF was not significantly different between those transferred as compared to those who directly present to our CSC, discharges to ARF were significantly longer among those who were transferred to our CSC. Future efforts should be made to examine potential reasons for prolonged LOS among this group of patients.