Abstract WP205: Outcomes for Intracerebral Hemorrhage Patients Undergoing Interhospital Transfers versus Direct Admissions in a Large Urban Health System

Introduction: The American Heart Association (AHA) recommends transferring intracerebral hemorrhage (ICH) patients to centers with multidisciplinary teams for timely, comprehensive management. ICH patients undergoing interhospital transfers (IHT) may face worsened outcomes due to delays and neurological deterioration during IHT. Our health system has a centralized triage and transfer program, Neuroemergencies Management and Transfers (NEMAT), which engages a command center and multidisciplinary teams to improve safety and efficiency. We evaluated outcomes among ICH patients admitted directly via emergency department (ED) versus those who underwent IHT via NEMAT to our comprehensive stroke center (CSC). Methods: Data was obtained from Get With the Guidelines (GWTG) and NEMAT QA databases at Mount Sinai Hospital (1/1/21 to 5/30/25). Outcomes included discharge disposition, length of stay (LOS), and change in modified Rankin Scale (mRS) from premorbid baseline to discharge. Predictor variables were transfer status, sex, age, ICH score, pre-stroke mRS, and in-hospital mortality. Outcomes were analyzed by transfer status (Fisher’s exact test for discharge, Wilcoxon rank-sum test for LOS, and t-test for mRS change) and with regression models (multinomial for discharge, gamma distribution for LOS, linear model for mRS change). Results: Among 204 ICH patients, 39.7% were transfers, 48% female, median age 62 (IQR 23.5 years), median ICH score 1 (IQR 3), median pre-stroke mRS 0, and 24% deceased. Discharge disposition included 90 to rehabilitation facilities, 53 to home, 49 deceased, 8 to acute care facility, 3 left against medical advice, and 1 to hospice. Median LOS was 12.9 days (IQR 19.6) and mean change in mRS was 2.9 (SD 1.97). Transfer status was not associated with discharge disposition (p>0.9). Transfers had longer LOS (median shift: 5.47 days, p=0.013), but this was not significant after adjusting for sex, age, ICH score, and in-hospital mortality (17.7% increase in LOS, 95% CI: -21.8% to 74.9%, p=0.423). Transfer status was not associated with a change in mRS, in adjusted analysis (β=-0.24, p=0.525). Conclusion: In a health system with a centralized triage and transfers system, interhospital transfer to a CSC was not associated with differences in functional outcomes, discharge disposition, or adjusted hospital stay among ICH patients. Future studies should assess how IHT affects time to definitive intervention and outcomes in different care settings.