A Real-World Perspective on Interfacility Transfers of Acute Ischemic Stroke from a Semi-Rural Center

• 作者: Ester Puyuelo Francisco Sanchez-Mendez Lluís Llauger
• 来源期刊: 急诊医学(英文)
• 学科: 医学
• 关键词: STROKE EMERGENCY ROOM TRANSPORTATION of Patients PROGNOSIS
• 年，卷（期）: 2020,（1）
• 页码范围: 1-12
• 页数: 12页
• 分类号: R74

摘要

Introduction: Interfacility transfers (IFT) of acute ischemic stroke (AIS) may not always lead to a better prognosis. Methods: Retrospective cohort study included AIS patients at an emergency department (ED) with telestroke. Multiple linear regression for departure time from ED (DT), quantile regression for length of in-hospital stay (LOS), and Kaplan-Meier estimator with Cox proportional hazards model for one-year survival (SV) were performed. Results: 192 patients included were categorised according to IFT. Mechanical thrombectomy was performed in 50% who had been transferred. Differences were found in DT, discharge disposition and LOS. An inverse relationship existed between DT and NIHSS. The strongest predictor of LOS was TACS (β = 3.14 [0.03 - 8.49];p = 0.005). SV was related to IFT (HR 4.68 [1.37 - 16.07];p = 0.014), age (HR 1.1 [1.04 - 1.17]), BI Conclusions: Shared decision-making with a stroke unit through telemedicine enabled a standardised clinical management in a non-metropolitan setting. Several improvement opportunities were identified: multimodal computed tomography availability before transfer, as well as optimization of response time and training in neurosonology of emergency physicians.