Association of transfer time and delays with outcomes for patients with acute pulmonary embolism requiring interhospital transfer: a retrospective observational study

Interhospital transfer (IHT) for pulmonary embolism (PE) is increasingly performed to improve access to advanced reperfusion therapies, but it is unclear if IHT times influence overall outcomes. We studied the association between transfer times and outcomes of patients with acute PE requiring IHT. 139 patients with acute PE undergoing IHT to the Mount Sinai Health System between September 2021 and June 2023 were retrospectively studied. Primary outcomes were 30-day mortality and 30-day major bleeding. ‘Door to IHT’ time was defined as the time from diagnosis of acute PE to the time patient physically arrived in the receiving hospital. Patients were divided into groups based on quartiles of ‘door to IHT’ time; those within the first and fourth quartiles of ‘door to IHT’ time were compared using propensity score-weighted analyses. The propensity score was calculated from six variables: age, sex, BMI [Body Mass Index], PESI [PE Severity Index] score, ESC [European Society of Cardiology] risk class and presence of a central PE. Multivariable regression models were fitted within the propensity score-matched sample to assess the association of ‘door to IHT’ time with primary outcomes. Median age of included patients was 61 years and 76 (54.7%) were women. Median PESI score was 88 points. Median ‘door to IHT’ time was 10.8 (IQR: 7.3–19.4) hours. Rates of 30-day mortality and 30-day major bleeding were 7.2% and 2.2%. Within propensity score-weighted analyses, no significant associations were found between ‘door to IHT’ time and any of the primary outcomes (30-day mortality or 30-day major bleeding). In this retrospective study of patients with acute PE undergoing IHT, differences in ‘door to IHT’ time were not significantly associated with 30-day mortality or 30-day major bleeding. This suggests that delays in IHT do not adversely influence outcomes of patients with acute PE undergoing IHT.

肺栓塞（pulmonary embolism, PE）患者的院间转运（interhospital transfer, IHT）应用日益增多，旨在提升患者接受高级再灌注治疗的可及性，但目前尚不清楚院间转运时长是否会对患者整体预后产生影响。本研究旨在探讨需行院间转运的急性肺栓塞患者的转运时长与预后之间的关联。本研究回顾性分析了2021年9月至2023年6月期间，139例需转运至西奈山医疗系统（Mount Sinai Health System）的急性肺栓塞患者。本研究的主要结局为30天死亡率与30天大出血发生率。“入院至转运时长（Door to IHT）”定义为从确诊急性肺栓塞至患者实际抵达接收医院的时长。研究对象按“入院至转运时长”的四分位数进行分组，并采用倾向得分加权分析对处于第1与第4四分位数区间的患者组进行比较。倾向得分基于6项变量计算得到：年龄、性别、体重指数（Body Mass Index, BMI）、肺栓塞严重程度指数（PE Severity Index, PESI）评分、欧洲心脏病学会（European Society of Cardiology, ESC）危险分层，以及是否存在中央型肺栓塞。在倾向得分匹配的样本中构建多变量回归模型，以评估“入院至转运时长”与主要结局之间的关联。纳入研究的患者中位年龄为61岁，其中女性76例，占比54.7%。患者的中位PESI评分为88分。“入院至转运时长”的中位值为10.8小时（四分位距：7.3~19.4小时）。30天死亡率与30天大出血发生率分别为7.2%与2.2%。经倾向得分加权分析后，未发现“入院至转运时长”与任一主要结局（30天死亡率或30天大出血发生率）存在显著关联。在这项针对需行院间转运的急性肺栓塞患者的回顾性研究中，“入院至转运时长”的差异与30天死亡率及30天大出血发生率均无显著关联。这表明院间转运的延迟并不会对接受院间转运的急性肺栓塞患者的预后产生不良影响。