title: Clinical Outcomes among Transferred Children with Ischemic and Hemorrhagic Strokes in the Nationwide Inpatient Sample.
abstract: BACKGROUND
  Children with ischemic stroke (IS) and hemorrhagic stroke (HS) may require interfacility transfer for higher level of care. We compared the characteristics and clinical outcomes of transferred and nontransferred children with IS and HS.
  
  
  METHODS
  Children aged 1-18 years admitted to hospitals in the United States from 2008 to 2011 with a primary discharge diagnosis of IS and HS were identified from the National Inpatient Sample database by ICD-9 codes. Using logistic regression, we estimated the odds ratios (OR) and 95% confidence intervals (CI) for in-hospital mortality and discharge to nursing facilities (versus discharge home) between transferred and nontransferred patients.
  
  
  RESULTS
  Of the 2815 children with IS, 26.7% were transferred. In-hospital mortality and discharge to nursing facilities were not different between transferred and nontransferred children in univariable analysis or in multivariable analysis that adjusted for age, sex, and confounding factors. Of the 6879 children with HS, 27.1% were transferred. Transferred compared to nontransferred children had higher rates of both in-hospital mortality (8% versus 4%, P = .003) and discharge to nursing facilities (25% versus 20%, P = .03). After adjusting for age, sex, and confounding factors, in-hospital mortality (OR 1.5, 95% CI 1.1-2.4, P = .04) remained higher in transferred children, whereas discharge to nursing facilities was not different between the groups.
  
  
  CONCLUSIONS
  HS but not IS was associated with worse outcomes for children transferred to another hospital compared to children who were not transferred. Additional study is needed to understand what factors may contribute to poorer outcomes among transferred children with HS.
authors.affiliation: Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana. Electronic address: malikmuhammad.adil@gmail.com.
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.affiliation: Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Vidal
authors.affiliation: Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D016017:Odds Ratio; D010351:Patient Discharge; D010360:Patient Transfer; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Ischemic stroke; childhood stroke; hemorrhagic stroke; transferred children