Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke: The Madrid Stroke Network Experience
| Autor: | José Luis Caniego, Á. Ximénez-Carrillo, Gustavo Zapata-Wainberg, Eduardo Bárcena, María Alonso de Leciñana, Fernando Díaz-Otero, Patricia Martínez-Sánchez, Gerardo Ruiz-Ares, Begoña Marín, A. Cruz-Culebras, Antonio Gil-Núñez, Exuperio Díez-Tejedor, Jaime Masjuan, Jose C. Méndez, Eduardo Fandiño, R. Frutos, Andrés Fernández-Prieto, Blanca Fuentes, José Vivancos, Andrés García-Pastor |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Patient Transfer congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Endovascular revascularization medicine.medical_treatment Brain Ischemia medicine Humans Prospective Studies Registries Endovascular treatment Intensive care medicine Stroke Acute ischemic stroke Patient transfer Aged Advanced and Specialized Nursing business.industry Endovascular Procedures nutritional and metabolic diseases Thrombolysis Middle Aged medicine.disease Treatment Outcome Spain PATIENT TRANSFERS Observational study Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Medical Futility |
| Zdroj: | Stroke. 46(8) |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose— The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors. Methods— We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift). Results— The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%). Conclusions— Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided. |
| Databáze: | OpenAIRE |
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