Patel Ruchit V, Tong Lilin, Molyneaux Bradley J, Patel Nirav J, Aziz-Sultan Mohammed A, Dhand Amar, Bi Wenya Linda
Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Front Neurol. 2024 Jul 31;15:1409713. doi: 10.3389/fneur.2024.1409713. eCollection 2024.
Intracranial hemorrhages present across a spectrum of clinical phenotypes, with many patients transferred across hospitals to access higher levels of neurocritical care. We sought to characterize patient dispositions following intracranial hemorrhage and examine disparities associated with interhospital transfers.
Using the Healthcare Cost and Utilization Project database, we mapped and identified factors influencing the likelihood of patient transfers and receipt of specialist interventional procedures following intracranial hemorrhage.
Of 11,660 patients with intracranial hemorrhage, 59.4% had non-traumatic and 87.5% single compartment bleeds. After presentation, about a quarter of patients were transferred to another facility either directly from the ED (23.0%) or after inpatient admission (1.8%). On unadjusted analysis, patients who were white, in the upper income quartiles, with private insurance, or resided in suburban areas were more frequently transferred. After adjusting for patient-and hospital-level variables, younger and non-white patients had higher odds of transfer. Hospital capabilities, residence location, insurance status, and prior therapeutic relationship remained as transfer predictors. Transferred patients had a similar hospital length of stay compared to admitted patients, with 43.1% having no recorded surgical or specialist interventional procedure after transfer.
Our analysis reveals opportunities for improvement in risk stratification guiding transfers, as well as structural challenges likely impacting transfer decisions.
颅内出血呈现出一系列临床表型，许多患者会转诊至其他医院以获得更高水平的神经重症监护。我们试图描述颅内出血后患者的处置情况，并研究与院间转诊相关的差异。
利用医疗保健成本与利用项目数据库，我们梳理并确定了影响颅内出血后患者转诊可能性及接受专科介入治疗的因素。
在11660例颅内出血患者中，59.4%为非创伤性出血，87.5%为单腔出血。就诊后，约四分之一的患者直接从急诊科（23.0%）或住院后（1.8%）转诊至另一机构。未经调整的分析显示，白人、收入处于四分位上半区、有私人保险或居住在郊区的患者转诊更为频繁。在对患者和医院层面的变量进行调整后，年轻患者和非白人患者转诊的几率更高。医院能力、居住地点、保险状况和既往治疗关系仍是转诊的预测因素。与入院患者相比，转诊患者的住院时间相似，43.1%的转诊患者在转诊后未记录有手术或专科介入治疗。
我们的分析揭示了在指导转诊的风险分层方面有待改进的机会，以及可能影响转诊决策的结构性挑战。
