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Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy

Retrospective Analysis of a Regional Stroke Registry with 2797 Patients

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Abstract

Background and Purpose

This study aimed at comparing short-term clinical outcome after thrombectomy in patients directly admitted (DA) to a comprehensive stroke center with patients secondarily transferred (ST) from a primary stroke center.

Methods

In a prospective regional stroke registry, all stroke patients with a premorbid modified Rankin scale (mRS) score 0–2 who were admitted within 24 h after stroke onset and treated with thrombectomy between 2014 and 2017 were retrospectively analyzed. Patients with DA and ST were compared regarding the proportion of good outcome (discharge mRS 0–2), median discharge mRS, mRS shift (difference between premorbid mRS and mRS on discharge) and occurrence of symptomatic intracranial hemorrhage.

Results

Out of 2797 patients, 1051 (37.6%) achieved good clinical outcome. In the DA group (n = 1657), proportion of good outcome was higher (DA 42.2% vs. ST 30.9%, P < 0.001) and median discharge mRS (DA 3 vs. ST 4, P < 0.001) and median mRS shift (DA 3 vs. ST 4, P < 0.001) were lower. The rate of symptomatic intracranial hemorrhage was similar in both groups (DA 9.3% vs. ST 7.5%, P = 0.101). Multivariate analysis revealed that direct admission was an independent predictor of good clinical outcome (adjusted odds ratio, OR 1.32, confidence interval, CI 1.09–1.60, P = 0.004).

Conclusion

These results confirm prior studies stating that DA to a comprehensive stroke center leads to better outcome compared to ST in stroke patients undergoing thrombectomy.

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Abbreviations

CSC:

Comprehensive stroke center

DA:

Direct admission

EVT:

Endovascular thrombectomy

IVT:

Intravenous thrombolysis

ST:

Secondary transfer

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Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Fatih Seker, Susanne Bonekamp, Martin Bendszus & Markus A. Möhlenbruch

  2. Qualitätssicherung im Gesundheitswesen Baden-Württemberg GmbH, Stuttgart, Germany

    Susanne Rode & Sonja Hyrenbach

Authors
  1. Fatih Seker
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  2. Susanne Bonekamp
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  3. Susanne Rode
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Contributions

F. Seker, S. Bonekamp, M. Bendszus and M.A. Möhlenbruch conceived the study and initiated the study design. S. Hyrenbach and S. Rode contributed to acquisition of data. F. Seker, M. Bendszus and M.A. Möhlenbruch contributed to analysis and interpretation of data. All authors contributed to refinement of the study protocol and reviewed and approved the final manuscript.

Corresponding author

Correspondence to Markus A. Möhlenbruch.

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Conflict of interest

F. Seker, S. Bonekamp, S. Rode, S. Hyrenbach, M. Bendszus and M.A. Möhlenbruch declare that they have no competing interests.

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Seker, F., Bonekamp, S., Rode, S. et al. Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy. Clin Neuroradiol 30, 795–800 (2020). https://doi.org/10.1007/s00062-019-00842-9

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  • DOI: https://doi.org/10.1007/s00062-019-00842-9

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