Impact of prehospital comprehensive stroke center vs. primary stroke center triage protocol on outcome of patients with spontaneous intracerebral hemorrhage.
Journal of Stroke and Cerebrovascular Diseases · 2026-01-07 · Quasi-experimental
Abstract
PURPOSE: While prehospital triage protocols for suspected large vessel occlusion (LVO) improve ischemic stroke outcomes, their impact in spontaneous intracerebral hemorrhage (sICH) remain uncertain. We evaluated whether a regional LVO-focused emergency medical service (EMS) transport protocol affected time-based process outcomes and clinical outcomes in sICH patients. METHOD: We conducted a multicenter pre-post implementation retrospective cohort study using the Get-With-The-Guidelines-Stroke database in Chicago (April 2017-January 2020). Included were EMS-transported sICH patients arriving ≤6 hours from last known normal at 8 comprehensive stroke centers (CSCs) and 15 primary stroke centers (PSCs). In September 2018, EMS implemented the 3-Item Stroke Scale (3I-SS) to triage suspected LVO stroke patients; those scoring ≥4 were routed to a CSC bypassing PSC. Primary outcome was favorable discharge disposition (home/acute rehabilitation). Secondary outcomes included in-hospital mortality, good neurologic outcome (independent ambulation) at discharge and time based process outcomes (door-to-CT, symptom-to-arrival, symptom-to-CT). Interrupted time series (ITS) analysis assessed changes while accounting for temporal trends. FINDINGS: Among 303 sICH patients (111 pre-, 192 post-implementation), there was no difference in favorable discharge disposition (58% vs. 64%, p=0.3), in-hospital mortality (12% vs. 9%, p=0.4) or good neurologic outcomes (13% vs. 19%, p=0.4) between pre-post implementation periods for both unadjusted or ITS analyses. Time based process outcomes showed no significant changes in unadjusted or ITS analyses. The protocol also did not impact CSC admission and inter-hospital transfer rates in ITS analyses. DISCUSSION/CONCLUSION: Implementation of an LVO-focused EMS transport protocol did not improve clinical outcomes or time-based process outcomes among sICH patients, nor did it influence CSC admission or transfer rates. These findings suggest that while beneficial for ischemic stroke care, LVO triage protocols may not confer the same advantages for sICH patients and may require tailored approaches for this population.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Mortality & survival · Time intervals · Triage instruments
Related articles
- Patients with acute intracerebral hemorrhage and severe symptoms are highly sensitive to prehospital delay. A subgroup analysis from the RESIST and TRIAGE-STROKE trials. (Front Stroke, 2024)
- The Stockholm Stroke Triage Project: Outcomes of Endovascular Thrombectomy Before and After Triage Implementation. (Stroke, 2022)
- Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures. (Prehosp Emerg Care, 2016)
- Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke. (Stroke Vasc Interv Neurol, 2023)
- Impact of prehospital stroke triage implementation on patients with intracerebral hemorrhage. (Ther Adv Neurol Disord, 2023)
- Beyond the Golden Hour: Treating Acute Stroke in the Platinum 30 Minutes. (Stroke, 2022)