TY - JOUR
T1 - Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers
T2 - An Urban Population-Based Study
AU - Katz, Brian S.
AU - Adeoye, Opeolu
AU - Sucharew, Heidi
AU - Broderick, Joseph P.
AU - McMullan, Jason
AU - Khatri, Pooja
AU - Widener, Michael
AU - Alwell, Kathleen S.
AU - Moomaw, Charles J.
AU - Kissela, Brett M.
AU - Flaherty, Matthew L.
AU - Woo, Daniel
AU - Ferioli, Simona
AU - MacKey, Jason
AU - Martini, Sharyl
AU - De Los Rios La Rosa, Felipe
AU - Kleindorfer, Dawn O.
N1 - Funding Information:
Dr Khatri's department receives financial support for her research efforts from Genentech (PRISMS [A Phase IIIB, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of Alteplase in Patients With Mild Stroke: Rapidly Improving Symptoms and Minor Neurologic Deficits] Lead Principal Investigator). She has received fees from Biogen (data safety and monitoring board member), coinvestigator fees from Novartis/MedPace (coinvestigator), St Jude's (consultant), medicolegal consultations, UpToDate, Inc, (online publication royalties), and Grand Rounds Experts, Inc (online clinical consultation). Dr Flaherty received financial support as Principal Investigator of the NINDS funded STOP-IT Study [The Spot Sign for Predicting and Treating Intracerebral Hemorrhage Growth Study] with study drug supplied by Novo-Nordisk. He is a cofounder, SENSE Diagnostics, LLC. Dr Broderick received research monies from Genentech for PRISMS Trial; travel to Australian stroke conference paid for by Boehringer Ingelheim. Study medication from Genentech for IMS III Trial [Interventional Management of Stroke] and study catheters supplied during Versions 1 to 3 by Concentric Inc, KOS Corp, and Cordis Neurovascular. Dr Adeoye is a cofounder, SENSE Diagnostics, LLC. Dr Kleindorfer received financial support from Genentech, modest level, for speaker's bureau fees. The other authors report no conflicts.
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - 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.
AB - 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.
KW - Emergency Medical Services
KW - hospitals
KW - stroke
KW - triage
UR - http://www.scopus.com/inward/record.url?scp=85023740235&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.116.015971
DO - 10.1161/STROKEAHA.116.015971
M3 - Article
C2 - 28701576
AN - SCOPUS:85023740235
VL - 48
SP - 2164
EP - 2170
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 8
ER -