Acute Ischemic Stroke: Acute Management and Selection for Endovascular Therapy

Dhand, Sabeen; O’Connor, Paul; Hughes, Charles W.; Lin, Shao-Pow

doi:10.1055/s-0040-1709152

Cited by 4 publications

(2 citation statements)

References 68 publications

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“…Reduction in door-to-groin time remains an important benchmark to advance the treatment of acute ischemic stroke patients with large vessel occlusions. Although several multitier, lean quality improvement initiatives have been developed to optimize workflow, [23][24][25][26][27] our study provides evidence that focusing efforts on pre-transfer vascular imaging alone yields powerful results. Furthermore, our findings underscore an important implementation opportunity for emergency medicine leaders that also facilitates collaboration across disciplines and health systems.…”

Section: Discussionmentioning

confidence: 79%

Single-step Optimization in Triaging Large Vessel Occlusion Strokes: Identifying Factors to Improve Door-to-groin Time for Endovascular Therapy

Rawson¹,

Petrone²,

Adcock³

2023

WestJEM

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Although acute stroke endovascular therapy (EVT) has dramatically improved outcomes in acute ischemic stroke (AIS) patients with large vessel occlusions (LVO), access to EVT-capable centers remains limited, particularly in rural areas. Therefore, it is essential to optimize triage systems for EVT-eligible patients. One strategy may be the use of a telestroke network that typically consists of multiple spoke sites that receive a consultation to determine appropriateness of patient transfer to an EVT-capable hub site. Standardization of AIS protocols may be necessary to achieve target door-togroin (DTG) times of less than 60 minutes in EVT-eligible patients upon hub arrival. Specifically, the decision to obtain vascular imaging at the transferring hub site vs delaying until arrival at the hub is controversial. The purpose of this study was to identify factors associated with reduced DTG time in LVO-AIS patients.Methods: We performed a retrospective chart review for all patients treated over a 3.5-year period at our home hub institution. Patients were classified as telestroke transfers, non-telestroke transfers, and direct-to-hub presentations. We recorded demographic information, DTG time, reperfusion status, length of stay (LOS), functional status at discharge, seven-day mortality, and the site where vascular imagingcomputed tomography angiography (CTA)-was obtained. We performed binary logistic regression to identify factors associated with DTG <60 minutes.Results: In the sample of EVT-eligible patients (n = 383), CTA was performed at the spoke site prior to transfer to the hub institution in 53% of cases. Further, 59% of telestroke transfer cases received a CTA prior to transfer compared to only 40% of non-telestroke transfers (59 vs 40%, P = 0.01). A Door-to-groin time <60 minutes was achieved in 67% of transfer patients who received pre-transfer CTA compared to only 22% of transfer patients who received CTA upon hub arrival and 17% of patients who presented directly to the hub. Ultimately, transfer patients who received CTA prior to transfer were 7.2 times more likely to have a DTG <60 minutes compared to those who did not (OR 7.2, 95% confidence interval 3.5-14.7; P < 0.001). Conclusion:Pre-transfer computed tomography angiography was the only significant predictor of achieving target door-to-groin times of less than 60 minutes. Because DTG time has been well established as a predictor of clinical outcomes, including pre-transfer CTA in a standardized acute ischemic stroke protocol may prove beneficial. Our findings also illustrate the need to optimize direct-tohub stroke alerts and telestroke relationships to minimize workflow disruptions, which became more apparent during the pandemic. [

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Section: Discussionmentioning

confidence: 79%

Single-step Optimization in Triaging Large Vessel Occlusion Strokes: Identifying Factors to Improve Door-to-groin Time for Endovascular Therapy

Rawson¹,

Petrone²,

Adcock³

2023

WestJEM

View full text Add to dashboard Cite

show abstract

“…Delays in seeking treatment may also result from social distancing measures introduced during the COVID pandemic [9]. In prepandemic times 96% of stroke emergency calls were activated by caregivers and witnesses [5,25]. Instructions to avoid contact with others means there is less opportunity for the symptoms to be witnessed or disclosed to others [9].…”

Section: Discussionmentioning

confidence: 99%

Simulating Delay in Seeking Treatment for Stroke due to COVID-19 Concerns with a Hybrid Agent-Based and Equation-Based Model

Hunter,

McGarry,

Kelleher

2022

Preprint

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COVID-19 has caused tremendous strain on healthcare systems worldwide. At the same time, concern within the population over this strain and the chances of becoming infected has potentially reduced the likelihood of people seeking medical treatment for other health events. Stroke is a medical emergency and swift treatment can make a large difference in patient outcomes. Understanding how concern over the COVID-19 pandemic might impact the time delay in seeking treatment after a stroke can be important in understanding both the long term cost implications and how to target individuals during another pandemic scenario to remind them of the importance of seeking treatment immediately. We present a hybrid agent-based and equation-based model to simulate the delay in seeking treatment for stroke due to concerns over COVID-19 and show that even small changes in behaviour impact the average delay in seeking treatment for the population. This delay could potentially impact the outcomes for stroke patients and future healthcare costs to support them. We find that introducing control measures and having multiple smaller peaks of the pandemic results in less delay in seeking treatment compared to a scenario with one large peak.

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Simulating Delay in Seeking Treatment for Stroke Due to COVID-19 Concerns with a Hybrid Agent-Based and Equation-Based Model

Hunter

McGarry

Kelleher

2022

Springer Proceedings in Complexity

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Acute Ischemic Stroke: Acute Management and Selection for Endovascular Therapy

Cited by 4 publications

References 68 publications

Single-step Optimization in Triaging Large Vessel Occlusion Strokes: Identifying Factors to Improve Door-to-groin Time for Endovascular Therapy

Single-step Optimization in Triaging Large Vessel Occlusion Strokes: Identifying Factors to Improve Door-to-groin Time for Endovascular Therapy

Simulating Delay in Seeking Treatment for Stroke due to COVID-19 Concerns with a Hybrid Agent-Based and Equation-Based Model

Simulating Delay in Seeking Treatment for Stroke Due to COVID-19 Concerns with a Hybrid Agent-Based and Equation-Based Model

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