Introduction: With the advent of stroke systems of care and mechanical thrombectomy, appropriate and timely triage and transport have become vital topics. We evaluated transport patterns for thrombectomy patients, analyzing outcomes related to aspects of transport to our Comprehensive Stroke Center (CSC).
Methods: From 07/2011 to 03/2017, all patients who underwent thrombectomy for stroke at our institution were reviewed. Demographics, comorbidities, time intervals, NIHSS scores, and inpatient outcome were evaluated. Multivariate analyses were performed; p-value 0.05 was significant.
Results: 166 patients met criteria. Mean age was 62.6 +/- 14.8 years with 46.4% female. Mean BMI was 29.6+/-6.8. Comorbidity prevalences were: Hypertension (80.7%); Hypercholesterolemia (44.0%), Diabetes (25.9%), Tobacco use (38.6%). Figure 1 shows the time intervals for patients brought directly to the CSC vs. to an outside hospital (OSH) and then transferred to the CSC; with significant within-group variations, there were no significant differences in time from Last Known Normal to Recanalization. Patients who arrived to the CSC via air transport vs. ground transport were significantly older, with significantly higher rates of concomitant heart disease, and had a significantly higher in-hospital mortality. There was no difference in admission NIH Stroke Scale or Discharge NIH Stroke Scale between those arriving via air transport or via ground transport.
Conclusions: Stroke Systems of Care must focus on appropriate triage and transport for mechanical thrombectomy. Whether arriving directly to a Comprehensive Stroke Center, or being transferred through another institution, one of the longest time intervals remains the Last Known Normal to first hospital time. Thus, further research and education is needed to improve stroke awareness and first-responder triage.
Patient Care: It will aid in optimizing transport and triage of ELVO patients for thrombectomy.
Learning Objectives: 1. Understand the time points involved in direct versus transfer of patients with emergent large vessel occlusion to a Comprehensive Stroke Center.
2. Learn about factors involved in transport of patients for thrombectomy.