Intrinsic hospital factors: overlooked cause for variations in delay to transfer for endovascular thrombectomy

Background Intrinsic hospital factors leading to time delay inter-hospital transfer for endovascular thrombectomy (EVT) have not been adequately investigated, uncertainty in generalizability of hub and spoke EVT services. We investigated the contribution intrinsic variations a multicenter, retrospective study. Methods The setting was state-wide system population 6.3 million 34 hospitals. collected data on acute large vessel occlusion strokes transferred from consideration between January 2016 December 2018. primary endpoint proportion variability delay-time cases contributed by estimated through variance component analysis implemented as mixed-effect linear regression model with hospitals random effects. Results included 434 patients. median age 72 years (IQR 62–79), 44% were female, baseline National Institutes Health Stroke Scale (NIHSS) 16 11–20). onset CT 100 mins 69–157) at acquisition 93 min 70–132). 53% observed center explained factors, opposed patient-related factors. Conclusions more than half departure transfer. recommend that design services should account minimize delay.