(1305) Rural-Urban Differences in Interhospital Transfer Patients Undergoing Mechanical Thrombectomy

Introduction: Mechanical thrombectomy (MT) is the standard of care for patients with ischemic stroke caused by large vessel occlusion (IS-LVO). Rural stroke care has been shown to be associated with poorer outcomes compared to their urban counterparts. However, clinical characteristics and differences in hospital course between groups have not been well described. This study investigated predictors and hospital courses among transfer patients who underwent MT to treat IS-LVO, from both rural and urban hospitals.

Methods: We retrospectively reviewed charts of adult patients with IS-LVO and MT who were transferred to a Comprehensive Stroke Center (UMMC) between 2015-2018. Primary outcome was percentage of good function, defined as 90-day modified Rankin scale (mRS-90 score 0-2). Forward stepwise multivariable logistic regression was used to identify predictors for good outcome.

Results: We analyzed 259 patients’ charts, 96 (37%) transferred from rural hospitals. Age, NIHSS, rates of good reperfusion (TICI 2b/2c/3) were similar between rural and urban-transferred patients. Ground distance was longer for rural patients (difference [Diff.] of 51km [95%CI -42, 53], < 0.001), time from Stroke Team consult to arrival at our center was longer for rural patients (Diff. -21 minutes, 95% CI -29, -21, p< 0.001), but patient’s LKW-to-recanalization (LKW-recan) interval [Difference 3 minutes [95% CI -7, 14]) and rates of good mRS (Diff. -0.08, 95%CI -0.21) was similar (p>0.05) between both groups. In multivariable logistic regression, each minute delay from LKW-recan was associated with lower odds of achieving good 90-day mRS (OR 1.04, 95%CI 0.997-0.999, p=0.015).

Conclusions: Rural patients were associated with larger transport ground distance from our comprehensive stroke center. Time from LKW to recanalization was essential for patients’ good neurologic outcome. Although further studies are needed to confirm our observations, clinicians should attempt to minimize the LKW-recanalization time for all stroke patients, especially those from rural areas.