What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Ischemic stroke (n=824551). Intervention: Emergent interfacility transfer vs. No transfer. Primary outcome: Presentation to a critical access hospital (OR 2.8, 95% CI 2.4-3.3).

What does this research mean for the field?

Emergent interfacility transfers for ischemic stroke in the United States decreased after 2019, reversing prior trends of continual increase, and remain strongly associated with initial presentation to critical access hospitals. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To characterize the demographic, clinical, and facility-level features of patients undergoing emergent interfacility transfer for acute ischemic stroke and evaluate nationwide volume trends from 2016 to 2022.

September 17, 2026Neurology

Trends in Emergent Interfacility Ischemic Stroke Transfers, 2016–2022

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Key result

Presentation to critical access hospitals is linked to ~2.8-fold higher odds of emergent stroke transfer.

OR 2.8
95% CI 2.4-3.3
n=824,551

Why the study?

Understanding the population emergently transferred for ischemic stroke care is critical to optimizing stroke systems of care.

Population

824,551 Medicare fee-for-service beneficiaries aged 65 years or older admitted with ischemic stroke

Comparison

Emergent interfacility transfer vs no emergent transfer

Design

Nationwide longitudinal cross-sectional study using Medicare claims

Authors

MGMatthew GuslerThe Ohio State University CDChristos DeligkarisThe Ohio State University Wexner Medical Center AZAlicia ZhaThe Ohio State University Wexner Medical Center

Discussion

Member takes

Implication

Emergent transfers for ischemic stroke in the US decreased from 2019 to 2022, and are strongly associated with presentation to smaller, rural, or non-stroke center facilities.

Key Points

To characterize the demographic, clinical, and facility-level features of patients undergoing emergent interfacility transfer for acute ischemic stroke and evaluate nationwide volume trends from 2016 to 2022.
Nationwide longitudinal cross-sectional analysis using Medicare fee-for-service (FFS) claims (2016–2022) of patients aged 65 years or older admitted with acute ischemic stroke (N=824,551).
County-level Medicare Advantage penetration rates were used to extrapolate nationwide transfer volumes.
Multilevel logistic regression was performed to evaluate patient and facility characteristics associated with emergent transfer versus non-transfer.
Of 824,551 FFS beneficiaries, 99,751 (12%) were emergently transferred and were younger (mean 78.2 vs 80.1 years) with higher rates of thrombectomy (15.9% vs 2.8%) and thrombolysis (24.1% vs 10.0%) compared to non-transferred patients.
Estimated nationwide transfers rose from 21,221 (12% of admissions) in 2016 to 26,720 (15%) in 2019, then dropped to 21,902 (12%) in 2022.
Transfer was positively associated with presentation to critical access hospitals (OR 2.8, 95% CI 2.4–3.3), prestroke hemiplegia (OR 2.3, 95% CI 2.3–2.4), and prestroke cerebrovascular disease (OR 2.2, 95% CI 2.2–2.3), while presenting to hospitals with >400 beds strongly reduced transfer odds (OR 0.01, 95% CI 0.01–0.01).

Study Design

Type

Cross-Sectional (n=824,551)

Multicenter

Yes

Structured PICO

Population

824,551 Medicare fee-for-service beneficiaries aged 65 years or older admitted for ischemic stroke between 2016 and 2022.

Exposure

Emergent interfacility transfer for ischemic stroke care

Comparator

No emergent transfer (admitted and treated at presenting facility)

Outcome

Trends in emergent transfer rates and features distinguishing transferred from non-transferred populations

Main Result

Odds Ratio: 2.8 (95% CI 2.4–3.3)

Absolute Event Rate: 24.9% vs 2.8%

Emergent transfers for ischemic stroke in the US decreased from 2019 to 2022, and are strongly associated with presentation to smaller, rural, or non-stroke center facilities.

Cite This Study

Gusler et al. (2026) conducted a cross-sectional in Ischemic stroke (n=824,551). Emergent interfacility transfer vs. No transfer was evaluated on Presentation to a critical access hospital (OR 2.8, 95% CI 2.4-3.3). Emergent interfacility transfers for ischemic stroke decreased since 2019, and were strongly associated with presentation to a critical access hospital (OR 2.8; 95% CI 2.4-3.3).

synapsesocial.com/papers/6aabb5fd5f706d05830e462a https://doi.org/10.1212/wnl.0000000000218499

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Implication

Emergent transfers for ischemic stroke in the US decreased from 2019 to 2022, and are strongly associated with presentation to smaller, rural, or non-stroke center facilities.

Trends in Emergent Interfacility Ischemic Stroke Transfers, 2016–2022

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Trends in Emergent Interfacility Ischemic Stroke Transfers, 2016–2022

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider