title: Admission facility is associated with outcome of basilar artery occlusion.
abstract: OBJECTIVE
  Basilar artery occlusion (BAO) is a stroke subtype with poor prognosis, but recanalizing therapies have been reported to be effective. We investigated whether initial admission to telemedically linked general hospitals with subsequent stroke-center transfer is related to poorer outcome than direct admission to stroke centers.
  
  
  METHODS
  All BAO cases of 3 stroke centers in Munich and 1 center in Regensburg between March 1, 2003 and December 31, 2004 were included, either if patients were directly admitted to stroke centers (n=23) or had initial admission to general hospitals of the telemedical network for integrative stroke care (TEMPiS) and secondary transfer to stroke centers (n=16). BAO was defined as angiographically (CTA, MRI or conventional angiography) confirmed occlusion of the basilar artery. Baseline parameters and therapeutic procedures were recorded. One-year follow-up was conducted prospectively.
  
  
  RESULTS
  Differences in baseline parameters were not statistically significant. Time from onset to first angiography was significantly longer in patients with secondary transfer (mean: 355+/-93 minutes versus 222+/-198 minutes; P<0.01), mainly attributable to transfer duration (mean:156+/-73 minutes). In-hospital mortality (22% versus 75%; P<0.01) and 1-year-mortality (30% versus 81%; P<0.01) were lower for patients with direct admission to stroke centers. Fifty-two percent of directly admitted patients versus 13% of patients with secondary transfer (P=0.02) were living at home after 1 year.
  
  
  CONCLUSIONS
  BAO patients who were admitted primarily to community hospitals had a worse prognosis. Patients with typical symptoms should have direct access to stroke centers, or may need bridging therapies.
authors.affiliation: Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Müller
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: Bijan
authors.initials: B
authors.lastname: Vatankhah
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mayer
authors.forename: Johannes
authors.initials: J
authors.lastname: Schenkel
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
authors.forename: Dirk
authors.initials: D
authors.lastname: Sander
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000592:standards / Q000706:statistics & numerical data; D011379:Prognosis; D011787:Quality of Health Care; D013038:Specialization; D020521:Stroke / Q000517:prevention & control / Q000628:therapy*; D017216:Telemedicine / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000628:therapy*