Transfer patients with anticoagulation-associated intracerebral hemorrhage had 512 vs 273 min to anticoagulant reversal and 22% lower adjusted odds of in-hospital death vs direct admits.
Does transfer admission compared to direct admission affect timeliness of care and clinical outcomes in patients with anticoagulation-associated intracerebral hemorrhage?
Transfer patients with anticoagulation-associated intracerebral hemorrhage experience longer delays to reversal but have less severe strokes and lower in-hospital mortality compared to directly admitted patients.
Absolute Event Rate: 0% vs 0%
Background Patients with anticoagulation‐associated intracerebral hemorrhage are often transferred from the presenting hospital to one with additional resources. Understanding differences in timeliness and care, including anticoagulant reversal, between transfer and direct admissions may identify quality improvement opportunities. Methods This cross‐sectional study included all hospitals in the American Heart Association GWTG–Stroke (Get With The Guidelines–Stroke) registry where anticoagulant reversal was administered (2015–2021). Patients with anticoagulation‐associated intracerebral hemorrhage presenting within 24 hours of onset and with information on prior AC treatment were included. Outcomes included functional score at discharge, in‐hospital death/discharge to hospice, discharge ambulatory status, discharge destination, and length of stay. Results Of 30 590 patients with AC‐ICH, 14 882 (48.6%) were transfers. Symptom onset to AC reversal was longer for transfer patients who received anticoagulant reversal at the admitting hospital versus direct‐admission patients (512 interquartile range 328–840 versus 273 interquartile range, 153–579 minutes; absolute standardized mean difference, 75.9%). Transfer patients had milder stroke severity on admission versus direct‐admission patients on the basis of National Institute of Health Stroke Scale (7 interquartile range, 2–19 versus 11 interquartile range, 3–22; absolute standardized mean difference, 21.2%) and intracerebral hemorrhage scores (1.81±1.36 versus 2.02±1.47; absolute standardized mean difference, 13.7%). In an adjusted logistic regression model, transfer patients had lower odds of in‐hospital death/discharge to hospice (adjusted odds ratio, 0.78 95% CI, 0.72–0.85), but no difference in discharge functional score, ambulatory status, or discharge home versus direct‐admission patients. Conclusions Transfer patients with anticoagulation‐associated intracerebral hemorrhage had longer times to reversal at the admitting hospital, less severe intracerebral hemorrhage, and lower odds of in‐hospital death versus direct‐admission patients after adjustment.
Royan et al. (Tue,) reported a other. Transfer patients with anticoagulation-associated intracerebral hemorrhage had 512 vs 273 min to anticoagulant reversal and 22% lower adjusted odds of in-hospital death vs direct admits.