title: Transfer time to a high-volume center for patients with subarachnoid hemorrhage does not affect outcomes.
abstract: OBJECTIVE
  The objective of our study was to examine patients with aneurysmal subarachnoid hemorrhage transferred and directly admitted to our institution in order to determine how transfer time affects outcomes.
  
  
  METHODS
  A retrospective cohort study was performed of all patients undergoing treatment for aneurysmal subarachnoid hemorrhage between 2005 and 2012 at the University of Michigan. Variables, including transfer time, were tested for their independent association with the primary outcomes of symptomatic vasospasm and 12-month outcome as well as secondary outcomes of aneurysm rebleeding and 12-month mortality.
  
  
  RESULTS
  During the study period, 263 (87.4%) patients were transferred to our institution and 38 (12.6%) were directly admitted for treatment of aneurysmal subarachnoid hemorrhage. Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. Higher Hunt-Hess grade was associated with the occurrence of symptomatic vasospasm as well as with poorer 12-month outcome.
  
  
  CONCLUSIONS
  Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. We believe our data argue that protocols should emphasize early resuscitation and stabilization followed by safe transfer rather than a hyperacute transfer paradigm. However, transfer time should be minimized as much as possible so as not to delay time to definitive treatment.
authors.affiliation: Department of Neurosurgery University of Michigan, Ann Arbor, Michigan. Electronic address: thowil@med.umich.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery University of Michigan, Ann Arbor, Michigan.
authors.forename: Yamaan
authors.initials: Y
authors.lastname: Saadeh
authors.affiliation: Department of Neurosurgery University of Michigan, Ann Arbor, Michigan.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.affiliation: Department of Neurosurgery University of Michigan, Ann Arbor, Michigan.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.affiliation: Bronson Methodist Hospital, Kalamazoo, Michigan.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.affiliation: Bronson Methodist Hospital, Kalamazoo, Michigan.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.affiliation: Department of Neurosurgery University of Michigan, Ann Arbor, Michigan.
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.affiliation: Department of Neurosurgery University of Michigan, Ann Arbor, Michigan; Bronson Methodist Hospital, Kalamazoo, Michigan.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm; subarachnoid hemorrhage; transfer; vasospasm