RT Journal Article
SR Electronic
T1 Field triage for endovascular stroke therapy: a population-based comparison
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 233
OP 239
DO 10.1136/neurintsurg-2019-015033
VO 12
IS 3
A1 Jayaraman, Mahesh V
A1 Hemendinger, Morgan L
A1 Baird, Grayson L
A1 Yaghi, Shadi
A1 Cutting, Shawna
A1 Saad, Ali
A1 Siket, Matt
A1 Madsen, Tracy E
A1 Williams, Ken
A1 Rhodes, Jason
A1 Haas, Richard A
A1 Furie, Karen L
A1 McTaggart, Ryan A
YR 2020
UL http://jnis.bmj.com/content/12/3/233.abstract
AB 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.