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. 2021 Aug 26:12:730250.
doi: 10.3389/fneur.2021.730250. eCollection 2021.

Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy

Laura C C van Meenen  1 , Frank Riedijk  2 , Jeffrey Stolp  1 , Bas van der Veen  3 , Patricia H A Halkes  3 , Taco C van der Ree  4 , Charles B L M Majoie  5 , Yvo B W E M Roos  1 , Martin D Smeekes  2 , Jonathan M Coutinho  1
Affiliations

Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy

Laura C C van Meenen et al. Front Neurol. .

Abstract

Background: Patients with large vessel occlusion (LVO) stroke are often initially admitted to a primary stroke center (PSC) and subsequently transferred to a comprehensive stroke center (CSC) for endovascular thrombectomy (EVT). This interhospital transfer delays initiation of EVT. To identify potential workflow improvements, we analyzed pre- and interhospital time metrics for patients with LVO stroke who were transferred from a PSC for EVT. Methods: We used data from the regional emergency medical services and our EVT registry. We included patients with LVO stroke who were transferred from three nearby PSCs for EVT (2014-2021). The time interval between first alarm and arrival at the CSC (call-to-CSC time) and other time metrics were calculated. We analyzed associations between various clinical and workflow-related factors and call-to-CSC time, using multivariable linear regression. Results: We included 198 patients with LVO stroke. Mean age was 70 years (±14.9), median baseline NIHSS was 14 (IQR: 9-18), 136/198 (69%) were treated with intravenous thrombolysis, and 135/198 (68%) underwent EVT. Median call-to-CSC time was 162 min (IQR: 137-190). In 133/155 (86%) cases, the ambulance for transfer to the CSC was dispatched with the highest level of urgency. This was associated with shorter call-to-CSC time (adjusted β [95% CI]: -27.6 min [-51.2 to -3.9]). No clinical characteristics were associated with call-to-CSC time. Conclusion: In patients transferred from a PSC for EVT, median call-to-CSC time was over 2.5 h. The highest level of urgency for dispatch of ambulances for EVT transfers should be used, as this clearly decreases time to treatment.

Keywords: acute ischemic stroke; endovascular thrombectomy; interhospital; large vessel occlusion; prehospital/EMS; time to treatment; workflow.

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Conflict of interest statement

CM reports grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation, Stryker, and Health Evaluation Netherlands, all outside the submitted work (paid to institution), and is shareholder of Nico.lab, a company that focuses on the use of artificial intelligence for medical image analysis. YR is a minor shareholder of Nico.lab. JC received unrelated research support from the Dutch Heart Foundation, Bayer, Boehringer, and Medtronic. All fees were paid to his employer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Median time intervals from symptom onset to arrival at the CSC. CSC, comprehensive stroke center; EMS, emergency medical services; IVT, intravenous thrombolysis; PSC, primary stroke center. Not included in figure: median time between first call to dispatch center and first ambulance dispatch: 1 min; median time between second call to dispatch center and second ambulance dispatch: 1 min.
See this image and copyright information in PMC

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