Impact of interhospital transfer on complications and outcome after intracranial hemorrhage

Neurocrit Care. 2012 Dec;17(3):324-33. doi: 10.1007/s12028-012-9679-z.

Abstract

Background: Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications.

Methods: A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and subdural hemorrhage (SDH), admitted to the neuro-ICU at a tertiary-care academic hospital. Admission demographics, complications and 3-month functional outcomes were compared between directly admitted and transferred patients. The effect of transfer time on complications and outcomes was assessed.

Results: Of 257 total patients, 120 (47%) were transferred and 137 (53%) were directly admitted. About 86 (34%) had SAH, 80 (31%) had ICH and 91 (35%) had SDH. The median transfer time was 190 min (46-1,446). Transferred patients were significantly less educated, less likely to be insured and more frequently had SAH as a diagnosis than directly admitted patients (all P < 0.05), though admission neurological and cognitive status was similar. Complications did not differ between transferred and directly admitted patients; however, among transferred patients, longer transfer time was associated with aneurysm rebleed (7.3 vs. 1.8%, P = 0.007) and tracheostomy (20 vs. 17.5%, P = 0.013). In multivariate analysis, after adjusting for other predictors, transferred patients had worse cognitive outcome at 3-months (adjusted OR 12.4, 95% CI 1.2-125.2, P = 0.033) compared to direct admits, though there were no differences in death, disability or length of stay (LOS).

Conclusions: Transferred patients had similar rates of death, disability and LOS as directly admitted patients, though worse 3-month cognitive outcomes. Prolonged time to interhospital transfer was associated with an increased risk of aneurysm rerupture and tracheostomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Illness / mortality
  • Disability Evaluation
  • Female
  • Hematoma, Subdural / mortality
  • Hematoma, Subdural / rehabilitation
  • Hematoma, Subdural / therapy
  • Hospital Mortality
  • Humans
  • Incidence
  • Intensive Care Units / statistics & numerical data
  • Intracranial Hemorrhages / mortality*
  • Intracranial Hemorrhages / rehabilitation
  • Intracranial Hemorrhages / therapy*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Transfer / statistics & numerical data*
  • Prospective Studies
  • Risk Factors
  • Subarachnoid Hemorrhage / mortality
  • Subarachnoid Hemorrhage / rehabilitation
  • Subarachnoid Hemorrhage / therapy
  • Tertiary Care Centers / statistics & numerical data*
  • Young Adult