The Impact of Rapid Transfer on the Prognosis of Aneurysmal Subarachnoid Hemorrhage: A Multi-center Cohort Study.

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) carries high mortality and disability. Existing studies largely focus on in-hospital treatment timing, whereas evidence on the prehospital window from symptom onset to arrival at an endovascular-capable hospital remains scarce, with multicenter data from China particularly lacking. This study investigated the association between prehospital transfer time (PTT) and clinical outcomes. This retrospective multicenter cohort study enrolled 726 adult aSAH patients from 7 comprehensive stroke centers in China. Patients were categorized into a rapid transfer group (PTT ≤8 h) and a delayed transfer group (PTT >8 h). Multivariable logistic regression models, adjusting for age, Hunt-Hess grade, modified Fisher grade and other confounders, were used to evaluate the independent effect of PTT on 6-month functional prognosis (poor outcome defined as modified Rankin Scale score >2), 12-month all-cause mortality, and in-hospital complications. After multivariable adjustment, delayed transfer was independently associated with a higher risk of 6-month poor functional outcome (adjusted OR 5.306, 95% CI 3.175-9.170, P<0.001) and increased 12-month all-cause mortality (adjusted OR 2.558, 95% CI 1.321-5.121, P=0.006). Delayed transfer also significantly increased the risk of in-hospital complications, including brain herniation, hydrocephalus, ischemic stroke, and aneurysmal rebleeding. Arrival at an endovascular-capable hospital within 8 hours of symptom onset is independently associated with better functional outcomes, lower mortality, and fewer severe complications in aSAH patients. Optimizing prehospital transfer to achieve the 8-hour treatment window should be a priority goal in regional stroke network construction.