Objective: Due to geographic disparities in stroke care, many acute ischemic stroke (AIS) patients are transferred to stroke centers for treatment with intravenous (IV) tissue plasminogen activator (tPA) or for post-tPA care. Advances in stroke treatment have improved patient outcomes and decreased hospital lengths of stay (LOS).
Hypothesis: We hypothesize that post-tPA patients transferred to stroke centers have longer LOS than those presenting to our emergency department (ED).
Methods: In a retrospective chart review from 2/14 - 5/15, we identified 400 patients who received tPA and were treated at our facility. Nine patients with in-hospital stroke were excluded. Baseline characteristics and clinical variables were abstracted. We compared the LOS (days - admit to discharge) of those presenting to our ED with those who were transferred to our facility. The baseline characteristics and clinical outcomes were compared between the two groups.
Results: Table 1 depicts baseline characteristics and clinical variables. Of the 391 patients included, 181 (46.3%) received tPA after presenting to our ED, and 210 (53.7%) patients were treated with tPA and transferred to our facility. The median length of stay was the same for the two groups (p=0.43). There was no difference in most baseline characteristics or clinical outcome variables, though arrival NIHSS was slightly lower in the transferred group (9 vs 11, p<0.05).
Conclusion: There was no difference in LOS or any clinical outcomes between the ED and transferred patients. Additionally, transferred patients did not receive more advanced procedures such as intra-arterial therapy or hemicraniectomy. Further studies exploring non-tPA patients and transient ischemic attack patients would be informative, as well as non-home, discharge location relative to the patient’s residence.