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Original research
Field triage for endovascular stroke therapy: a population-based comparison
  1. Mahesh V Jayaraman1,2,3,4,
  2. Morgan L Hemendinger2,
  3. Grayson L Baird1,5,
  4. Shadi Yaghi2,4,
  5. Shawna Cutting2,4,
  6. Ali Saad2,4,
  7. Matt Siket6,
  8. Tracy E Madsen6,
  9. Ken Williams6,
  10. Jason Rhodes7,
  11. Richard A Haas1,3,2,4,
  12. Karen L Furie2,4,
  13. Ryan A McTaggart1,3,2,4
  1. 1Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  2. 2Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  3. 3Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  4. 4The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island, USA
  5. 5Lifespan Biostatistics Core, Lifespan Hospital System, Providence, Rhode Island, USA
  6. 6Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  7. 7Department of Health, State of Rhode Island, Providence, Rhode Island, USA
  1. Correspondence to Professor Ryan A McTaggart, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; mctaggartr{at}gmail.com

Abstract

Background Endovascular therapy (EVT) for stroke improves outcomes but is time sensitive.

Objective To compare times to treatment and outcomes between patients taken to the closest primary stroke center (PSC) with those triaged in the field to a more distant comprehensive stroke center (CSC).

Methods During the study, a portion of our region allowed field triage of patients who met severity criteria to a more distant CSC than the closest PSC. The remaining patients were transported to the closest PSC. We compared times to treatment and clinical outcomes between those two groups. Additionally, we performed a matched-pairs analysis of patients from both groups on stroke severity and distance to CSC.

Results Over 2 years, 232 patients met inclusion criteria and were closest from the field to a PSC; 144 were taken to the closest PSC and 88 to the more distant CSC. The median additional transport time to the CSC was 7 min. Times from scene departure to alteplase and arterial puncture were faster in the direct group (50 vs 62 min; 93 vs 152 min; p<0.001 for both). Among patients who were independent before the stroke, the OR for less disability in the direct group was 1.47 (95% CI 1.13 to 1.93, p=0.003), and 2.06 (95% CI 1.10 to 3.89, p=0.01) for the matched pairs.

Conclusions In a densely populated setting, for patients with stroke who are EVT candidates and closest to a PSC from the field, triage to a slightly more distant CSC is associated with faster time to EVT, no delay to alteplase, and less disability at 90 days.

  • stroke
  • thrombectomy
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Footnotes

  • Contributors All authors: substantial contributions to the conception or design of the work; or 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.

  • 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.

  • Ethics approval Approved by the Lifespan institutional review board as a retrospective review of prospectively collected stroke center quality database, with waiver of informed consent.

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

  • Patient consent for publication Not required.

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