---
title: "Emergent Interfacility Transfers for Ischemic Stroke in the US, 2016–2022"
id: "pubmed-42743443"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42743443"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42743443/"
doi: "10.1212/WNL.0000000000218499"
published_at: "2026-09-15T22:39:59.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Emergent Interfacility Transfers for Ischemic Stroke in the US, 2016–2022
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42743443
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42743443/)
- **DOI:** [10.1212/WNL.0000000000218499](https://doi.org/10.1212%2FWNL.0000000000218499)
- **Published At:** 2026-09-15T22:39:59.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This nationwide longitudinal cross-sectional study used Medicare fee-for-service claims to characterize emergent interfacility transfers for **ischemic stroke** among beneficiaries aged 65 years or older from 2016 to 2022. - Among 824,551 fee-for-service admissions for ischemic stroke, 99,751 (12%) underwent emergent transfer and 724,800 (88%) were not transferred. - The transfer cohort was younger (mean 78.2 vs 80.1 years), had higher rates of **thrombectomy** (15.9% vs 2.8%) and **thrombolysis** (24.1% vs 10.0%) compared with nontransferred patients. - Transferred patients more often presented to rural facilities, hospitals with 400 beds (OR 0.01, 95% CI 0.01–0.01, reference ≤100 beds), being seen at a **stroke center** (OR 0.4, 95% CI 0.4–0.5), older age (OR 0.6, 95% CI 0.6–0.6), and greater affluence (4th quartile ADI OR 0.6, 95% CI 0.5–0.7). - The study extrapolated FFS findings using county-level Medicare Advantage penetration to estimate nationwide emergent transfers. Detailed methods and limitations beyond the abstract were not reported in the source.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 15. # Trends in Emergent Interfacility Ischemic Stroke Transfers, 2016-2022 [Matthew T Gusler](https://pubmed.ncbi.nlm.nih.gov/?term=Gusler+MT&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#full-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus."), [Christos Deligkaris](https://pubmed.ncbi.nlm.nih.gov/?term=Deligkaris+C&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#full-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus."), [Alicia M Zha](https://pubmed.ncbi.nlm.nih.gov/?term=Zha+AM&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#full-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus."), [James F Burke](https://pubmed.ncbi.nlm.nih.gov/?term=Burke+JF&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#full-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus.") Affiliations Expand ### Affiliation * 1 From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus. * PMID: **42743443** * DOI: [ 10.1212/WNL.0000000000218499 ](https://doi.org/10.1212/wnl.0000000000218499) Item in Clipboard # Trends in Emergent Interfacility Ischemic Stroke Transfers, 2016-2022 Matthew T Gusler et al. Neurology. 2026. Show details Display options Display options Format Abstract PubMed PMID Neurology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurology%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Neurology%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743443/) . 2026 Oct 13;107(7):e218499. doi: 10.1212/WNL.0000000000218499. Epub 2026 Sep 15. ### Authors [Matthew T Gusler](https://pubmed.ncbi.nlm.nih.gov/?term=Gusler+MT&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#short-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus."), [Christos Deligkaris](https://pubmed.ncbi.nlm.nih.gov/?term=Deligkaris+C&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#short-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus."), [Alicia M Zha](https://pubmed.ncbi.nlm.nih.gov/?term=Zha+AM&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#short-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus."), [James F Burke](https://pubmed.ncbi.nlm.nih.gov/?term=Burke+JF&cauthor_id=42743443)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743443/#short-view-affiliation-1 "From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus.") ### Affiliation * 1 From the Department of Neurology, The Ohio State University Wexner Medical Center, Columbus. * PMID: **42743443** * DOI: [ 10.1212/WNL.0000000000218499 ](https://doi.org/10.1212/wnl.0000000000218499) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background and objectives:** Interfacility transfer for emergent treatment is critical to stroke systems of care. Understanding the transfer population enables transfer system optimization. **Methods:** We performed a nationwide longitudinal cross-sectional study to characterize the population emergently transferred for ischemic stroke care from 2016 to 2022. Using Medicare fee-for-service (FFS) claims, we included patients 65 years or older admitted with ischemic stroke. County-level Medicare Advantage penetration rates were used to extrapolate the results to estimate nationwide emergent transfers. Multilevel logistic regression identified features distinguishing the transferred from the nontransferred population. **Results:** From 2016 to 2022, we identified 824,551 FFS beneficiaries (57% female) admitted for ischemic stroke: 99,751 (12%) underwent emergent transfer, while 724,800 (88%) were not transferred. The transfer population was younger (mean 78.2 years vs 80.1 years) with a higher rate of thrombectomy (15.9% vs 2.8%) and thrombolysis (24.1% vs 10.0%). Their presenting facility was more likely to be rural (55.3% vs 22.6%), have 400 beds (OR 0.01, 95% CI 0.01-0.01, reference ≤100 beds), a stroke center (OR 0.4, 95% CI 0.4-0.5), older age (OR 0.6, 95% CI 0.6-0.6), and more affluence (4th quartile of ADI OR 0.6, 95% CI 0.5-0.7). **Discussion:** Emergent transfers for ischemic stroke in the United States have decreased since 2019, reversing a long-standing trend of continual increase. Receipt of thrombectomy or thrombolysis, presentation to a small facility, a nonstroke center, or in a less affluent area are associated with the transfer population. 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