Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 May 1;90(18):e1561-e1569.
doi: 10.1212/WNL.0000000000005419. Epub 2018 Apr 4.

Interfacility transfers for US ischemic stroke and TIA, 2006-2014

Benjamin P George  1 , Sara J Doyle  2 , George P Albert  2 , Ania Busza  2 , Robert G Holloway  2 , Kevin N Sheth  2 , Adam G Kelly  2
Affiliations
Observational Study

Interfacility transfers for US ischemic stroke and TIA, 2006-2014

Benjamin P George et al. Neurology. .

Abstract

Objective: To investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA.

Methods: We performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006-2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time.

Results: The population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 (p trend < 0.001). The rate of IS/TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0-3.8) in 2006 to 7.6 (95% CI 7.2-7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0-10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1-33.3) (2006-2014) (p trend < 0.001). Transfers were more common among IS. Transfer rates were greatest among rural (adjusted odds ratio [AOR] 3.05, 95% CI 2.56-3.64) vs urban/teaching and low-volume EDs (AOR 7.49, 95% CI 6.58-8.53, 1st vs 4th quartile). The adjusted odds of transfer for IS/TIA increased threefold (2006-2014).

Conclusions: Interfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Emergency department (ED) visit selection
IS = ischemic stroke.
Figure 2
Figure 2. Changes in the number and rate of US ischemic stroke and TIA transfers, 2006–2014
(A) The number of acute care transfers over time is estimated using sampling weights and strata from the nationwide emergency department (ED) sample, which is an approximate 20% sample of US ED visits. (B) To correct for double-counting, the rate denominator includes nontransferred patient visits only.
Figure 3
Figure 3. Box and whisker plot of emergency department (ED) transfer rates
ED transfer rates for ischemic stroke and TIA by (A) hospital location/teaching status and (B) availability of neurosurgical procedures, 2006–2014. Outliers not shown.
Figure 4
Figure 4. Change in the rate of ischemic stroke and TIA transfers for emergency departments (EDs) sampled in 2006 and 2014
(A) Urban, teaching. (B) Urban, nonteaching. (C) Rural. Each point represents a unique ED within the dataset. The Y-axis represents the difference in ED transfer rate from 2006 to 2014.
See this image and copyright information in PMC

Comment in

References

    1. Pervez MA, Silva G, Masrur S, et al. . Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke 2010;41:e18–e24. - PMC - PubMed
    1. Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke 2012;43:2078–2085. - PubMed
    1. Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and ship thrombolytic therapy for acute ischemic stroke: use, temporal trends, and outcomes. Stroke 2015;46:732–739. - PubMed
    1. Rothwell PM, Giles MF, Chandratheva A, et al. . Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007;370:1432–1442. - PubMed
    1. Eavis P. Air ambulances offer a lifeline, and then a sky-high bill [online]. Available at: nytimes.com/2015/05/06/business/rescued-by-an-air-ambulance-but-stunned-.... Accessed July 12, 2017.

Publication types