{"doi":"10.1177/17474930241246952","title":"Clinical change during inter-hospital transfer for thrombectomy: Incidence, associated factors, and relationship with outcome","abstract":"Background: Patients with acute ischemic stroke with a large vessel occlusion (LVO) admitted to non endovascular-capable centers often require inter-hospital transfer for thrombectomy. We aimed to describe the incidence of substantial clinical change during transfer, the factors associated with clinical change, and its relationship with 3-month outcome. Methods: We analyzed data from two cohorts of acute stroke patients transferred for thrombectomy to a comprehensive center (Stanford, USA, November 2019 to January 2023; Montpellier, France, January 2015 to January 2017), regardless of whether thrombectomy was eventually attempted. Patients were included if they had evidence of an LVO at the referring hospital and had a National Institute of Health Stroke Scale (NIHSS) score documented before and immediately after transfer. Inter-hospital clinical change was categorized as improvement (⩾4 points and ⩾25% decrease between the NIHSS score in the referring hospital and upon comprehensive center arrival), deterioration (⩾4 points and ⩾25% increase), or stability (neither improvement nor deterioration). The stable group was considered as the reference and was compared to the improvement or deterioration groups separately. Results: A total of 504 patients were included, of whom 22% experienced inter-hospital improvement, 14% deterioration, and 64% were stable. Pre-transfer variables independently associated with clinical improvement were intravenous thrombolysis use, more distal occlusions, and lower serum glucose; variables associated with deterioration included more proximal occlusions and higher serum glucose. On post-transfer imaging, clinical improvement was associated with arterial recanalization and smaller infarct growth and deterioration with larger infarct growth. As compared to stable patients, those with clinical improvement had better 3-month functional outcome (adjusted common odds ratio (cOR) = 2.43; 95% confidence interval (CI) = 1.59–3.71; p < 0.001), while those with deterioration had worse outcome (adjusted cOR = 0.60; 95% CI = 0.37–0.98; p = 0.044). Conclusion: Substantial inter-hospital clinical changes are frequently observed in LVO-related ischemic strokes, with significant impact on functional outcome. There is a need to develop treatments that improves the clinical status during transfer. Data access statement: The data that support the findings of this study are available upon reasonable request.","journal":"International Journal of Stroke","year":2024,"id":440065,"datarank":0.3453877639491069,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.0,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6232,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1234913,"name":"Adrien ter Schiphorst","orcid":"0000-0002-7354-3351","position":1,"is_corresponding":false},{"id":1214438,"name":"Anke Wouters","orcid":"0000-0001-5229-2699","position":2,"is_corresponding":false},{"id":1235407,"name":"Nicole Yuen","orcid":null,"position":3,"is_corresponding":false},{"id":545437,"name":"Michael Mlynash","orcid":"0000-0001-7483-8699","position":4,"is_corresponding":false},{"id":841256,"name":"Caroline Arquizan","orcid":"0000-0001-7347-1039","position":5,"is_corresponding":false},{"id":545438,"name":"Jeremy J. Heit","orcid":"0000-0003-1055-8000","position":6,"is_corresponding":false},{"id":689223,"name":"Stephanie Kemp","orcid":"0000-0002-2804-6495","position":7,"is_corresponding":false},{"id":252221,"name":"Sören Christensen","orcid":"0000-0003-1242-3724","position":8,"is_corresponding":false},{"id":1234914,"name":"Denis Sablot","orcid":"0000-0002-9038-7119","position":9,"is_corresponding":false},{"id":1234915,"name":"Anne Wacongne","orcid":"0000-0002-3976-3772","position":10,"is_corresponding":false},{"id":1235408,"name":"Thibault Lalu","orcid":null,"position":11,"is_corresponding":false},{"id":842770,"name":"Vincent Costalat","orcid":null,"position":12,"is_corresponding":false},{"id":252224,"name":"Gregory W. Albers","orcid":"0000-0003-0263-4632","position":13,"is_corresponding":false},{"id":252223,"name":"Maarten G. Lansberg","orcid":"0000-0002-3545-6927","position":14,"is_corresponding":false},{"id":1231106,"name":"Pierre Seners","orcid":"0000-0002-2134-0691","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:00:57.233748Z","pmid":"38576067","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}