title: Resource Utilization for Patients with Intracerebral Hemorrhage Transferred to a Comprehensive Stroke Center.
abstract: BACKGROUND
  As a comprehensive stroke center (CSC), we accept transfer patients with intracerebral hemorrhage (ICH) in our region. CSC guidelines mandate receipt of patients with ICH for higher level of care. We determined resource utilization of patients accepted from outside hospitals compared with patients directly arriving to our center.
  
  
  METHODS
  From our stroke registry, we compared patients with primary ICH transferred to those directly arriving to our CSC from March 2011-March 2012. We compared the proportion of patients who utilized at least one of these resources: neurointensive care unit (NICU), neurosurgical intervention, or clinical trial enrollment.
  
  
  RESULTS
  Among the 362 patients, 210 (58%) were transfers. Transferred patients were older, had higher median Glasgow Coma Scale scores, and lower National Institutes of Health Stroke Scale scores than directly admitted patients. Transfers had smaller median ICH volumes (20.5 cc versus 15.2 cc; P = .04) and lower ICH scores (2.1 ± 1.4 versus 1.6 ± 1.3; P < .01). A smaller proportion of transfers utilized CSC-specific resources compared with direct admits (P = .02). Fewer transferred patients required neurosurgical intervention or were enrolled in trials. No significant difference was found in the proportion of patients who used NICU resources, although transferred patients had a significantly lower length of stay in the NICU. Average hospital stay costs were less for transferred patients than for direct admits.
  
  
  CONCLUSIONS
  Patients with ICH transferred to our CSC underwent fewer neurosurgical procedures and had a shorter stay in the NICU. These results were reflected in the lower per-patient costs in the transferred group. Our results raise the need to analyze cost-benefits and resource utilization of transferring patients with milder ICH.
authors.affiliation: Department of Neurology, University of Texas-Health Science Center at Houston, Houston, Texas.
authors.forename: Claude
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Department of Neurology, University of Texas-Health Science Center at Houston, Houston, Texas.
authors.forename: Osman
authors.initials: O
authors.lastname: Mir
authors.affiliation: Department of Neurology, University of Texas-Health Science Center at Houston, Houston, Texas.
authors.forename: Farhaan
authors.initials: F
authors.lastname: Vahidy
authors.affiliation: Department of Neurology, University of Texas-Health Science Center at Houston, Houston, Texas.
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Birmingham VA Medical Center, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: Department of Neurology, Gertrude H. Sergievsky Center, Columbia University, New York, New York.
authors.forename: Amelia
authors.initials: A
authors.lastname: Boehme
authors.affiliation: School of Public Health, University of Texas-Health Science Center at Houston, Houston, Texas.
authors.forename: Rigoberto
authors.initials: R
authors.lastname: Delgado
authors.affiliation: Department of Neurology, University of Texas-Health Science Center at Houston, Houston, Texas. Electronic address: sean.i.savitz@uth.tmc.edu.
authors.forename: Sean
authors.initials: S
authors.lastname: Savitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics / Q000628:therapy*
keywords: Stroke systems; comprehensive stroke center; hemorrhagic stroke; intracerebral hemorrhage