Abstract 88: Racial Differences in the Use of Helicopters for Emergent Transfer of Stroke Patients

Mary Vaughan Sarrazin; Enrique Leira

doi:10.1161/str.46.suppl_1.88

Background: Emergency inter-hospital transfer by helicopter provides clinical benefit by shortening transport time to tertiary facilities while providing specialized medical care. Racial differences in the use of helicopters for interhospital transfers have not been investigated. Objective: Investigate racial differences in the use of helicopters for elderly Medicare patients presenting to emergency departments (ED) for stroke. Methods: We used claims from 2010-2011 for Medicare patients with a previous diagnoses of atrial fibrillation to identify inter-hospital transfers, defined by an ED visit on the same day as admission for stroke. Patient demographics, rural residence, and comorbidity were determined from claims incurred during the 12 months prior to the stroke admission. Transfer distance was calculated using ED and admitting hospital zipcodes. Statistical analyses compared rates of helicopter use unadjusted and adjusted for patient demographics, stroke type, comorbidity, and geographic area. Results: We identified 37,648 stroke admissions with an emergent inter-hospital transfer, of which 10% were for cerebral hemorrhage and 90% for ischemic stroke. Overall, 79%, 11%, 6%, and 4% were white, black, Hispanic, and other non-white, respectively. Compared to white patients, blacks and Hispanics were more likely to reside in urban areas (87% and 92% vs 81%), and had higher comorbidity scores (3.15 and 3.13 vs. 2.87). Overall, 1.5%, 1.0%, 0.6%, 2.1% of black, Hispanic, other non-white race, and white patients were transported by helicopter. Helicopter use was higher for patients with cerebral hemorrhage versus ischemic stroke (14.1% vs. 2.1%). In risk adjusted analysis, black, Hispanic, and other non-white patients were only 0.56, 0.41, and 0.31 times as likely as whites to be transported by helicopter (p<.01). This pattern was similar in separate analysis of urban areas, but not in rural areas. In analysis stratified by census region, significant racial differences in helicopter use were found in the South and Midwest, but not in the West or Northeast. Conclusions: Significant racial differences in the use of helicopter emergent evacuation of stroke patients cannot be explained by geography/distance or stroke severity.

Abstract 88: Racial Differences in the Use of Helicopters for Emergent Transfer of Stroke Patients

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