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Stroke. 2015 Aug;46(8):2156-61. doi: 10.1161/STROKEAHA.115.009282. Epub 2015 Jun 23.

Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke: The Madrid Stroke Network Experience.

Author information

1
From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.). blanca.fuentes@salud.madrid.org.
2
From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).

Abstract

BACKGROUND AND PURPOSE:

The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors.

METHODS:

We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift).

RESULTS:

The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%).

CONCLUSIONS:

Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.

KEYWORDS:

endovascular treatment; neuroimaging; patient transfer; stroke; stroke networks

PMID:
26106117
DOI:
10.1161/STROKEAHA.115.009282
[Indexed for MEDLINE]

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