Clinical outcome of rural in-hospital-stroke patients after interhospital transfer for endovascular therapy within a telemedical stroke network in Germany: a registry-based observational study

ObjectivesLittle is known about in-hospital-stroke (IHS) patients with large vessel occlusion and subsequent transfer to referral centres for endovascular therapy (EVT). However, this subgroup is highly relevant given the substantial amount of IHS, the ongoing trend towards greater use of EVT and la...

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Published in:BMJ open 2024-01, Vol.14 (1), p.e071975-e071975
Main Authors: Leitner, Miriam Antonia, Hubert, Gordian Jan, Paternoster, Laura, Leitner, Moritz Immanuel, Rémi, Jan Martin, Trumm, Christoph, Haberl, Roman Ludwig, Hubert, Nikolai Dominik
Format: Article
Language:English
Subjects:
Adult neurology
Anticoagulants
Brain Ischemia - therapy
Clinical outcomes
Emergency medical care
Endovascular Procedures - adverse effects
Hospitals
Hospitals, Rural
Humans
Intervention
Ischemia
Mortality
Neurology
Neuroradiology
Observational studies
Patients
Pre-existing conditions
Registries
Regression analysis
Rural areas
Rural health care
Statistical analysis
Stroke
Stroke - diagnosis
Stroke medicine
Thrombectomy - adverse effects
Treatment Outcome
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Summary:ObjectivesLittle is known about in-hospital-stroke (IHS) patients with large vessel occlusion and subsequent transfer to referral centres for endovascular therapy (EVT). However, this subgroup is highly relevant given the substantial amount of IHS, the ongoing trend towards greater use of EVT and lack of EVT possibilities in rural hospitals. The study objective is to explore the clinical outcomes of this vulnerable patient group, given that both IHS and interhospital transfer are associated with worse clinical outcomes due to a higher proportion of pre-existing conditions and substantial time delays during transfer.Design and settingProspectively collected data of patients receiving EVT after interhospital transfer from 14 rural hospitals of the Telemedical Stroke Network in Southeast Bavaria (TEMPiS) between February 2018 and July 2020 was analysed.Participants49 IHS and 274 out-of-hospital-stroke (OHS) patients were included.Outcome measuresBaseline characteristics, treatment times and outcomes were compared between IHS and OHS. The primary endpoint was a 3-month modified Rankin Scale (mRS).ResultsIn IHS patients, atrial fibrillation (55.3% vs 35.9%, p=0.012), diabetes (36.2% vs 21.1%, p=0.024) and use of oral anticoagulants (44.7% vs 20.8%, p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2023-071975