| Summary: | Introduction Optimal triage strategies for patients suspected of acute ischemic stroke due to large vessel occlusion remains debated. Whereas secondary analyses from randomized trials have demonstrated no differences in thrombectomy outcomes in transferred vs direct presentation strokes (1‐2), several registry based cohorts reported worse functional outcomes in those with transferred presentation mode (3‐4). We explored the US national claims database to explore trends in presentation (transferred vs direct presentation) and their outcomes for EVT hospitalizations using a nationally representative sample. Methods National Inpatient Sample database was retrospectively explored from 2016 to 2020 for stroke hospitalizations with EVT. Outcomes were compared for EVT hospitalizations with direct vs transferred presentation at discharge. Outcomes included favorable discharge disposition (home without assistance); in‐hospital mortality; and radiographic intracranial hemorrhage (ICH). Results Among 100,865 admissions with EVT, 32,685 (32.4%) presented following hospital transfer for thrombectomy. The utilization of EVT in US nearly doubled during between 2017 to 2020, and the proportion of in‐hospital transfer for EVT remained unchanged during this period. White race, higher baseline NIHSS, hospital size and status (urban teaching vs rural), and hospital location were independent predictors of transferred status for EVT. Transferred status was significantly associated with a lower likelihood of achieving favorable outcome (OR: 0.80, CI: [0.72, 0.89], P<0.001) and a higher likelihood of ICH (1.18 [1.07, 1.31], P=0.001), whereas no differences were observed in early mortality following transferred vs direct presentation mode (1.07 [0.93, 1.23], P=0.33). Conclusion Nearly one in 3 EVTs in US is performed in patients presenting following transfer from another acute care hospital. Transferred presentation status was associated with worse clinical outcomes following EVT in a real‐world setting. Future studies are needed to determine the optimal triage strategies for patients suspected of harboring large vessel occlusion strokes.
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