Introduction: Acute stroke care has been revolutionized with the advent of intravenous alteplase and endovascular therapy. The number of centers in the United States equipped to offer endovascular therapy are limited, often necessitating inter-hospital transfer. We studied the outcomes of such patients in terms of mortality and disability, and attempted to determine the possible contributory factors in the early years of neurointervention for acute stroke management.
Methods: We used the Nationwide Inpatient Sample data to identify the acute stroke patients requiring transfer for endovascular treatment, the National Center for Health Statistics data to determine their location, the United States Census Bureau website for determining the population demographics, the Joint Commission data on the distribution of Primary Advanced and Comprehensive Stroke Centers, and the Human Resources and Services Administration data on delivery of medical care. We compared the outcomes in the four major regions of the country in terms of mortality and disability at discharge.
Results: Age above 80 years (p<0.05) and a high Charlson’s co-morbidity index (p<0.01) were consistent predictors for increased disability in transferred patients receiving endovascular therapy. Age greater than 80 years was also a predictor for higher mortality (p<0.001) in all regions. The prevalence of significant disability was higher in the Midwest compared to the national average (p=0.0147).
Conclusion: Distribution of healthcare facilities capable of offering endovascular treatments affects time to treatment and consequently, outcomes. Strategic triage system and distribution of Primary Advanced and Comprehensive Stroke Centers could help reduce disparities of outcomes.