Introduction Time remains a crucial factor in stroke progression. Rapid and complete revascularization has been well correlated with favorable clinical outcome in patients with acute ischemic stroke secondary to large vessel occlusion. To mitigate the deleterious effects due to treatment delay, an initiative has been implemented to shorten the time for patient processing, expediting LVO patients for immediate intervention. The Launchpad protocol was established to ensure admitting stroke patients are triaged quickly and accurately identified in order to reduce time from arrival to intervention, and overall to revascularization. Herein, we assess the efficacy of the Launchpad paradigm in triaging presenting stroke patients.
Methods A retrospective review of the stroke database was conducted between September 2014 and January 2016, 3 months prior and 13 months post Launchpad implementation. Prior to Launchpad, patients presenting with stroke were triaged through the traditional Emergency Department (ED) pathway. Through Launchpad, incoming patients bypass the traditional ED pathway and are taken straight for a CT scan by a dedicated stroke team. A CT scan positive for LVO and penumbral tissues will permit patients to continue through the Launchpad pathway for further evaluation and subsequent intervention. Time differences during patient triage before and after Launchpad initiation are assessed to determine the efficiency of this paradigm.
Results In total, 764 patients were identified in the retrospective analysis, 137 were admitted prior, and 627 were admitted post Launchpad implementation. In the pre-Launchpad cohort, the median time from admission to CT imaging was 20 minutes. Patients under the Launchpad paradigm showed a reduction in time from presentation to imaging of 5 minutes (p = 0.0004). An increase in efficiency by roughly 25% to CT was observed following Launchpad implementation.
Conclusion The streamlined stroke activation Launchpad protocol demonstrated an increased speed in patient admission and significant reduction in time from presentation to CT scan. This significant improvement in processing time allowed for an increased number of patients to meet the therapeutic window for IV tPA eligibility. A prospective trial will strengthen the current finding and support the implementation of this paradigm amongst other stroke centers.
Disclosures K. Sivakumar: None. S. Feuerwerker: None. D. Turkel-Parrella: None. A. Tiwari: None. J. Farkas: None. K. Arcot: None.
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