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. 2017 Aug;48(8):2164-2170.
doi: 10.1161/STROKEAHA.116.015971. Epub 2017 Jul 12.

Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study

Brian S Katz  1 , Opeolu Adeoye  1 , Heidi Sucharew  1 , Joseph P Broderick  1 , Jason McMullan  1 , Pooja Khatri  1 , Michael Widener  1 , Kathleen S Alwell  1 , Charles J Moomaw  1 , Brett M Kissela  1 , Matthew L Flaherty  1 , Daniel Woo  1 , Simona Ferioli  1 , Jason Mackey  1 , Sharyl Martini  1 , Felipe De Los Rios la Rosa  1 , Dawn O Kleindorfer  2
Affiliations

Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study

Brian S Katz et al. Stroke. 2017 Aug.

Abstract

Background and purpose: The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown.

Methods: Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1.3 million. Addresses of all patients' residences and hospitals were geocoded, and estimated travel times were calculated. We estimated the mean differences between the travel time for patients taken to an ASRH/PSC and the theoretical time had they been transported directly to the region's CSC.

Results: Of 929 patients with geocoded addresses, 806 were transported via Emergency Medical Service directly to an ASRH/PSC. Mean additional travel time of direct transport to the CSC, compared with transport to an ASRH/PSC, was 7.9±6.8 minutes; 85% would have ≤15 minutes added transport time. Triage of all stroke patients to the CSC would have added 727 patients to the CSC's census in 2010. Limiting triage to the CSC to patients with National Institutes of Health Stroke Scale score of ≥10 within 6 hours of onset would have added 116 patients (2.2 per week) to the CSC's annual census.

Conclusions: Emergency Medical Service triage to CSCs based on stroke severity and symptom duration may be feasible. The impact on stroke systems of care and patient outcomes remains to be determined and requires prospective evaluation.

Keywords: Emergency Medical Services; hospitals; stroke; triage.

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Figures

Figure 1
Figure 1
Geographic distribution of the 15 hospitals, including the only CSC (in red), in The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS).
Figure 2
Figure 2
Distribution of the differences in travel time between CSC and initial hospital among stroke patients transported by EMS to an ASRH/PSC hospital. Box plots depict the minimum, first quartile, median, third quartile and maximum values with the rectangle spanning the first to third quartile, the line segment inside the rectangle depicting the median, and the whiskers above and below the box show the locations of the minimum and maximum value. Mean +/− standard deviation of the distribution is indicated by the black dot with gray lines spanning the value of the standard deviation above and below the mean. Moderate and severe strokes were defined as rNIHSS ≥ 10 and rNIHSS ≥ 15 respectively.
Figure 3
Figure 3
Geographic Distribution of Estimated EMS Travel Times for Ischemic Stroke Patients in the GCNK Region from Their Residence to Hospital: Actual Hospital of Transport (Panel A), Theoretical Triage to CSC (Panel B), and the Difference in Travel Time Between Actual Hospital and CSC Triage (Panel C). Each dot represents the home address of a transported ischemic stroke patient, and the color of the dot represents the estimated EMS transport time, as shown in the legend.
See this image and copyright information in PMC

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