Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort.
Cerebrovascular Diseases Extra · 2021-01-01 · Observational study
Abstract
OBJECTIVE: The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system. METHODS: We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) ("actual" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times ("actual" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort. RESULTS: Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively. CONCLUSIONS: Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Time intervals · Triage instruments · Urban
Related articles
- Prehospital Stroke Triage to Route Patients Directly to a Thrombectomy Center: New York City First-Year Experience. (Stroke Vasc Interv Neurol, 2023)
- Cincinnati Prehospital Stroke Scale Implementation of an Urban County Severity-Based Stroke Triage Protocol: Impact and Outcomes on a Comprehensive Stroke Center. (J Stroke Cerebrovasc Dis, 2022)
- Personalized Prehospital Triage in Acute Ischemic Stroke. (Stroke, 2019)
- Prehospital triage to primary stroke centers and rate of stroke thrombolysis. (JAMA Neurol, 2013)
- The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. (Emerg Med J, 2015)
- Updated New York City Emergency Medical Services Acute Stroke Triage Protocol Reduces Interfacility Transfers and Time to Endovascular Thrombectomy for Emergent Large Vessel Occlusion Stroke Patients. (J Stroke, 2022)