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Patterns of Care and Clinical Outcomes in Patients with Cerebral Sinus Venous Thrombosis
Journal article   Peer reviewed

Patterns of Care and Clinical Outcomes in Patients with Cerebral Sinus Venous Thrombosis

Andrea Holcombe, Nicholas Mohr, Mudassir Farooqui, Sudeepta Dandapat, Biyue Dai, Cynthia B. Zevallos, Darko Quispe-Orozco, Fazeel Siddiqui and Santiago Ortega-Gutierrez
Journal of stroke and cerebrovascular diseases, Vol.29(12), pp.105313-105313
12/2020
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105313
PMID: 32992183

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Abstract

•Rurality and patterns of care are significant factors for clinical prognosis.•Prompt identification of Cerebral Venous Sinus Thrombosis (CVST) patients is challenging.•Comprehensive Stroke Centers (CSC) provides optimum management for CVST patients. Objectives: To explore the association between rurality, transfer patterns and level of care with clinical outcomes of CVST patients in a rural Midwestern state. Materials and Methods: CVST patients admitted to the hospitals between 2005 and 2014 were identified by inpatient diagnosis codes from statewide administrative claims dataset. Records were linked across interhospital transfers using probabilistic linkage. Rurality was defined by Rural-Urban Commuting Areas using the 2-category approximation. Driving distances were estimated using GoogleMaps Application Programming Interface. Hospital stroke certification was defined by the Joint Commission. Severity of CVST was estimated by cost of care corrected for inflation and cost-to-charge ratios. Outcome was discharge disposition and total length of stay (LOS). Wilcoxon rank-sum, Chi-square, Fisher's exact tests and linear and logistic regressions were used. Results: 168 CVST patients were identified (79.8% female; median age = 32, IQR = 24.0–45.5). Median LOS was four days (IQR = 2–7) and patients traveled a median of 8.1 miles (IQR = 2.5–28.5) to the first hospital; 42% of patients were transferred to a second hospital, 5% to a third. More than half (58.3%) bypassed the nearest hospital. 86% visit a primary or comprehensive stroke center (CSC) during their acute care. Rurality was not significantly associated with LOS or discharge disposition after adjusting for age, sex and cost of care. Patients in CSC demonstrated greater likelihood of being discharged home compared to at a primary stroke center after adjusting for age and disease severity (p = 0.008). Conclusions: While rurality was not significantly associated with LOS or disposition outcome, care at a CSC increases likelihood of being discharge home.
 Cerebral venous sinus thrombosis Rurality Systems of care Transfer patterns

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