University of Texas at Austin Dell Medical School, 1601 Trinity street, Austin, TX, USA.
Department of Neurology, Hartford Hospital, Hartford, CT, USA.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107951. doi: 10.1016/j.jstrokecerebrovasdis.2024.107951. Epub 2024 Aug 21.
The optimal triage strategy for patients suspected of acute ischemic stroke due to large vessel occlusion (LVO) remains debated. We explored trends in presentation mode and their outcomes for mechanical thrombectomy (MT) hospitalizations based on the National Inpatient Sample (NIS) database.
We retrospectively explored the NIS database from 2016 to 2020 for stroke hospitalizations with MT. We compared outcomes at discharge for MT hospitalizations with direct vs. transferred presentation. Outcomes comprised favorable discharge disposition (home without assistance), in-hospital mortality, and radiographic intracranial hemorrhage (ICH).
This study included 100,865 patients undergoing MT, of whom 32,685 patients (32.4 %) were transferred (median age 71[60-81] years, 16775(51.2 %) women). The utilization of MT in the U.S. nearly doubled during the study period, whereas the proportion of in-hospital transfers for MT remained unchanged (32.1-33.2 %). White race, higher presenting NIHSS, hospital size, status, and location were independent predictors of transferred status. Transferred status was significantly associated with a lower likelihood of achieving favorable outcome (OR:0.80,95 % CI: [0.72,0.89],P<0.001) and a higher likelihood of ICH (OR:1.18, 95 % CI:[1.07,1.31],P=0.001), whereas no association was observed between presentation mode and in-hospital mortality (OR:1.07,95 % CI:[0.93,1.23],P=0.33).
Patients with direct presentation for MT after a stroke had better discharge outcomes and a lower risk of hemorrhagic transformation compared to those who were transferred from another facility. Determining the optimal triage strategy for MT following LVO stroke is an insightful area for future clinical trials.
对于因大血管闭塞（LVO）而疑似急性缺血性脑卒中的患者，最佳分诊策略仍存在争议。我们基于国家住院患者样本（NIS）数据库，探讨了机械取栓（MT）住院患者就诊方式的变化趋势及其结局。
我们回顾性分析了 2016 年至 2020 年 NIS 数据库中 MT 治疗的脑卒中住院患者。比较了直接就诊和转院就诊 MT 患者的出院结局。结局包括出院时的良好安置（无需辅助即可回家）、院内死亡率和影像学颅内出血（ICH）。
这项研究共纳入了 100865 例行 MT 的患者，其中 32685 例（32.4%）为转院（中位年龄 71[60-81]岁，16775 例[51.2%]为女性）。在此期间，美国 MT 的使用率几乎翻了一番，而 MT 患者住院期间的转院比例保持不变（32.1-33.2%）。白人、更高的 NIHSS 评分、医院规模、类型和位置是转院状态的独立预测因素。转院状态与获得良好结局的可能性降低显著相关（OR：0.80，95%CI：[0.72，0.89]，P<0.001），ICH 的可能性增加（OR：1.18，95%CI：[1.07，1.31]，P=0.001），但与院内死亡率之间无相关性（OR：1.07，95%CI：[0.93，1.23]，P=0.33）。
与从其他医疗机构转来的患者相比，直接就诊 MT 的脑卒中患者出院结局更好，出血转化风险更低。对于 LVO 脑卒中后 MT 的最佳分诊策略，这是一个有意义的未来临床试验领域。
