Abstract WP174: Outcomes for Acute Ischemic Stroke Patients Undergoing Interhospital Transfers versus Direct Admissions in a Large Urban Health System

Introduction: Timely reperfusion therapies improve outcomes for acute ischemic stroke (AIS). The American Heart Association (AHA) recommends transferring patients with suspected large vessel occlusion to a Comprehensive Stroke Center (CSC) or thrombectomy-capable site for advanced interventions. The impact of interhospital transfer (IHT) on outcomes remains uncertain. Our health system has the Neuroemergencies Management and Transfers (NEMAT) program, a centralized triage system with a command center, and multidisciplinary teams to improve safety and efficiency. We compared outcomes for AIS patients directly admitted to a CSC versus those transferred via NEMAT. Methods: Data were obtained from Get With the Guidelines (GWTG) and NEMAT QA databases within the Mount Sinai Health System (1/1/21-5/30/25). Outcomes included discharge disposition, length of stay (LOS), and change in modified Rankin Scale (mRS) from admission to discharge. The primary predictor was transfer status, with covariates of sex, age, NIHSS on admission, pre-stroke mRS, and in-hospital mortality. Associations were analyzed using Fisher’s exact test for discharge, Wilcoxon rank-sum test for LOS, and t-test for mRS change. Multivariable regression models adjusted for covariates (multinomial for discharge, gamma for LOS, linear for change in mRS). Results: Of 1762 AIS patients, 29% were transfers, 47.8% female, median age 69 years (IQR 19), median NIHSS 4 (IQR 9), median pre-stroke mRS 0 (IQR 2), with 6.2% mortality. At discharge, 841 went home, 720 to a rehab, 109 expired, 38 left against medical advice (AMA), 33 to hospice, and 21 to acute-care facility. Median LOS was 6.96 days (IQR 9.58) and mean change in mRS 1.60 (SD 1.80). Transfer status was associated with longer LOS (median +2.9 days, p<0.001) and greater mRS change (mean +0.82 days, p<0.001), but not discharge disposition (p=1). Transfer status was associated with LOS in adjusted analysis (34.7% increase, adjusted median +2.4 days, p<0.001) and change in mRS (β=0.43, p<0.001). Discharge destination did not differ, except transfer patients were less likely to leave AMA(RR: 0.11, p=0.04). Conclusion: Acute ischemic stroke patients transferred to a CSC had a longer LOS and greater change in mRS but similar discharge destinations compared to direct admits. Further multicenter studies are needed to validate these findings and guide strategies to strengthen stroke systems of care across different settings.