Clinical Outcomes among Transferred Children with Ischemic and Hemorrhagic Strokes in the Nationwide Inpatient Sample

J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2594-2602. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.043. Epub 2016 Jul 21.


Introduction: Children with ischemic stroke (IS) and hemorrhagic stroke (HS) may require interfacility transfer for higher level of care. We compared the characteristics and clinical outcomes of transferred and nontransferred children with IS and HS.

Methods: Children aged 1-18 years admitted to hospitals in the United States from 2008 to 2011 with a primary discharge diagnosis of IS and HS were identified from the National Inpatient Sample database by ICD-9 codes. Using logistic regression, we estimated the odds ratios (OR) and 95% confidence intervals (CI) for in-hospital mortality and discharge to nursing facilities (versus discharge home) between transferred and nontransferred patients.

Results: Of the 2815 children with IS, 26.7% were transferred. In-hospital mortality and discharge to nursing facilities were not different between transferred and nontransferred children in univariable analysis or in multivariable analysis that adjusted for age, sex, and confounding factors. Of the 6879 children with HS, 27.1% were transferred. Transferred compared to nontransferred children had higher rates of both in-hospital mortality (8% versus 4%, P = .003) and discharge to nursing facilities (25% versus 20%, P = .03). After adjusting for age, sex, and confounding factors, in-hospital mortality (OR 1.5, 95% CI 1.1-2.4, P = .04) remained higher in transferred children, whereas discharge to nursing facilities was not different between the groups.

Conclusion: HS but not IS was associated with worse outcomes for children transferred to another hospital compared to children who were not transferred. Additional study is needed to understand what factors may contribute to poorer outcomes among transferred children with HS.

Keywords: Ischemic stroke; childhood stroke; hemorrhagic stroke; transferred children.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality
  • Brain Ischemia / therapy*
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Hospital Mortality
  • Humans
  • Infant
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / mortality
  • Intracranial Hemorrhages / therapy*
  • Length of Stay
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Nursing Homes
  • Odds Ratio
  • Patient Discharge
  • Patient Transfer*
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / therapy*
  • Time Factors
  • Treatment Outcome
  • United States