Timeliness of Care for Transferred and Directly Admitted Patients With Anticoagulation-Associated Intracerebral...

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.

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.

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.

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.