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Early Thrombectomy Outcomes in Transfer Patients

  • Artem T. Boltyenkov
    Correspondence
    Address for correspondence: Artem T. Boltyenkov, PhD, MBA, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY 11030.
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY

    Siemens Medical Solutions USA Inc., Malvern, PA
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  • Jason J. Wang
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY
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  • Ajay Malhotra
    Affiliations
    Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
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  • Jeffrey M. Katz
    Affiliations
    Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
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  • Gabriela Martinez
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY

    Siemens Medical Solutions USA Inc., Malvern, PA
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  • Pina C. Sanelli
    Affiliations
    Imaging Clinical Effectiveness and Outcomes Research, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY

    Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
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Published:January 16, 2021DOI:https://doi.org/10.1016/j.amj.2020.12.007

      Abstract

      Objective

      The optimal patient transportation destination of acute ischemic stroke (AIS) patients remains uncertain. The purpose of this study was to evaluate the predictive variables that determine stroke outcomes depending on the patient transportation destination.

      Methods

      We performed a retrospective study using an AIS database consisting of patients who underwent thrombectomy admitted to our institution from November 1, 2011, through October 1, 2018.

      Results

      A total of 171 patients were included in the statistical analysis; 42.1% (72/171) of patients were in the mothership group (directly admitted) and 57.9% (99/171) in the drip-and-ship group (transferred). Multivariable logistic regression revealed the predictive factors for favorable outcomes were driving distance (expressed in miles) between the patient's home and a comprehensive stroke center (CSC) (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.90-0.99; P = .035), absence of diabetes mellitus (OR = 3.60; 95% CI, 1.20-10.82; P = .022), lower National Institutes of Health Stroke Scale score at admission (OR = 0.91; 95% CI, 0.85-0.97; P = .003), and shorter symptom onset to CSC arrival time (expressed in hours) (OR = 0.84; 95% CI, 0.72-0.99; P = .038).

      Conclusions

      Our study revealed that a shorter driving distance between the patient's home and CSC, absence of diabetes, lower National Institutes of Health Stroke Scale score, and shorter onset to hospital arrival time positively impacted the outcomes of endovascularly treated AIS patients.
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