Introduction Patients being transferred from outside facilities are often excluded from intra-arterial therapy due to delays in transfer, evaluation and imaging. The Marcus Stroke and Neuroscience Center at Grady Memorial Hospital is a unique prototype for stroke reperfusion therapies in the future. The CT scanner and biplane angiography suite are housed in the intensive care unit. Patients being transferred from outside facilities are brought directly to the intensive care unit where imaging and reperfusion therapies can be performed rapidly. We sought to determine if there were time differences in patients evaluated in our emergency room compared to transfers from outside facilities.
Materials and Methods A prospective database of consecutive intra-arterial therapy at the Marcus Stroke Center was reviewed. Patients treated from October 2010–January 2012 were reviewed. We assessed demographic, radiographic and clinical variables in addition to if patients were transferred from outside facilities. We assessed times from CT to groin puncture for patients evaluated in our emergency room and compared them to patients transferred from outside hospitals. Patients with anterior circulation strokes <8 h from symptom onset were assessed. Patients with posterior circulation strokes were excluded. We performed Fisher's exact testing for categorical variables and student's t-test for continuous variables.
Results A total of 165 patients with a mean age of 66±13 years with a mean NIHSS of 19±5. A total of 109 (65%) patients were transferred from outside hospitals. Patients from outside facilities were significantly less likely to have hypertension (61% vs 81%, p<0.01) but there were no baseline differences in age, NIHSS, clot location and time from symptom onset. Patients transferred from outside facilities had significantly lower times from CT at our institution to groin puncture compared to patients from our emergency room (42±20 min vs 74±30 min, p<0.0001).
Conclusions The presence of a biplane angiography suite in the neurological intensive care unit may help to reduce times to reperfusion in patients being transferred from an outside facility. Developing systems of care to reduce times to reperfusion will require assessment of systems of care that focus on available resources. Efficient systems to treat patients from outside hospitals may help to improve the ability to offer treatments to more patients.
Competing interests R Nogueira: EV3, Rapid Medical, Concentric, CoAxia. B Glenn: None. S Belagaje: None. A Anderson: None. M Frankel: None. F Nahab: None. R Gupta: Concentric Medical, CoAxia, Rapid Medical, Codman Corp.
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