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Ischemic stroke
Original research
Long-term effect of field triage on times to endovascular treatment for emergent large vessel occlusion
  1. Mahesh V Jayaraman1,2,
  2. Grayson Baird3,
  3. Karim Oueidat3,
  4. Gino Paolucci2,
  5. Richard A Haas1,2,
  6. Radmehr Torabi2,4,
  7. Krisztina Moldovan2,5,
  8. Jason Rhodes6,
  9. John Potvin7,
  10. Nicole Alexander-Scott8,
  11. Shadi Yaghi2,9,
  12. Tracy Madsen2,10,
  13. Karen Furie2,9,
  14. Ryan A McTaggart1,2
  1. 1 Diagnostic Imaging, Neurology and Neurosurgery, Brown University, Providence, Rhode Island, USA
  2. 2 Neurovascular Center, Rhode Island Hospital, Providence, Rhode Island, USA
  3. 3 Diagnostic Imaging, Brown University, Providence, Rhode Island, USA
  4. 4 Neurosurgery and Diagnostic Imaging, Brown University, Providence, Rhode Island, USA
  5. 5 Neurosurgery, Brown University, Providence, Rhode Island, USA
  6. 6 Department of Health, State of Rhode Island, Providence, Rhode Island, USA
  7. 7 Division of Emergency Medical Services, City of East Providence, East Providence, Rhode Island, USA
  8. 8 Medicine, Brown University, Providence, Rhode Island, USA
  9. 9 Neurology, Brown University, Providence, Rhode Island, USA
  10. 10 Emergency Medicine, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Mahesh V Jayaraman, Diagnostic Imaging, Neurology and Neurosurgery, Brown University, Providence, RI 02903, USA; MJayaraman{at}Lifespan.org

Abstract

Background Delays to endovascular therapy (EVT) for stroke may be mitigated with direct field triage to EVT centers. We sought to compare times to treatment over a 5.5 year span between two adjacent states, one with field triage and one without, served by a single comprehensive stroke center (CSC).

Methods During the study period, one of the two states implemented severity-based triage for suspected emergent large vessel occlusion, while in the other state, patients were transported to the closest hospital regardless of severity. We compared times to treatment and clinical outcomes between these two states. We also performed a matched pairs analysis, matching on date treated and distance from field to CSC.

Results 639 patients met the inclusion criteria, 407 in State 1 (with field triage) and 232 in State 2 (without field triage). In State 1, scene to EVT decreased 6% (or 8.13 min, p=0.0004) every year but no decrease was observed for State 2 (<1%, p=0.94). Cumulatively over 5.5 years, there was a reduction of 43 min in time to EVT in State 1, but no change in State 2. Lower rates of disability were seen in State 1, both for the entire cohort (all OR 1.22, 95% CI 1.07 to 1.40, p=0.0032) and for those independent at baseline (1.36, 95% CI 1.15 to 1.59, p=0.0003).

Conclusions Comparing adjacent states over time, the implementation of severity-based field triage significantly reduced time to EVT.

  • Stroke
  • Thrombectomy

Data availability statement

Data available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019250

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    Data availability statement

    Data available upon reasonable request.

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    Footnotes

    • Twitter @potvinj41

    • Correction notice Since this paper was published, the surname Ouediat has been updated to Oueidat.

    • Contributors We certify that all co-authors provided: substantial contributions to the conception and design of the work; the acquisition, analysis, or interpretation of data for the work; AND drafting the work or revising it critically for important intellectual content; AND final approval of the version to be published; AND agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MVJ (first author) is the guarantor of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.