Improving Transfer Times for Acute Ischemic Stroke Patients to a Comprehensive Stroke Center

Kodankandath, Thomas V.; Wright, Paul; Power, Paul; Geronimo, Marcella De; Libman, Richard B.; Kwiatkowski, Thomas; Katz, Jeffrey M.

doi:10.1016/j.jstrokecerebrovasdis.2016.09.008

Cited by 26 publications

(23 citation statements)

References 15 publications

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“…Compared to initial routing to a PSH and inter-hospital transfer to a TCH, initial routing to a TCH has been repeatedly reported to lead to faster treatment and a greater chance of good outcome. 16 17 18 However, previous studies registered patients who received EVT in the comprehensive stroke center, and could not investigate the impact of initial routing to a TCH compared to a PSH with regard to the accessibility to EVT in the whole EVT-eligible population. Furthermore, they were conducted by most of voluntarily participated large centers, they may not be representative of whole real-world practice.…”

Section: Discussionmentioning

confidence: 99%

Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement

et al. 2020

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Background To track triage, routing, and treatment status regarding access to endovascular treatment (EVT) after acute ischemic stroke (AIS) at a national level. Methods From national stroke audit data, potential candidates for EVT arriving within 6 hours with National Institute of Health Stroke Scale score of ≥ 7 were identified. Acute care hospitals were classified as thrombectomy-capable hospitals (TCHs, ≥ 15 EVT cases/year) or primary stroke hospital (PSH, < 15 cases/year), and patients' initial routes and subsequent inter-hospital transfer were described. Impact of initial routing to TCHs vs. PSHs on EVT and clinical outcomes were analyzed using multilevel generalized mixed effect models. Results Out of 14,902 AIS patients, 2,180 (14.6%) were EVT candidates. Eighty-one percent of EVT candidates were transported by ambulance, but only one-third were taken initially to TCHs. Initial routing to TCHs was associated with greater chances of receiving EVT compared to initial routing to PSHs (33.3% vs 12.1%, P < 0.001; adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.59–2.92) and favorable outcome (38.5% vs. 28.2%, P < 0.001; aOR, 1.52; 95% CI, 1.16–2.00). Inter-hospital transfers to TCHs occurred in 17.4% of those initially routed to a PSH and was associated with the greater chance of EVT compared to remaining at PSHs (34.8% vs. 7.5%, P < 0.001), but not with better outcomes. Conclusion Two-thirds of EVT candidates were initially routed to PSHs despite greater chance of receiving EVT and having favorable outcomes if routed to a TCH in Korea. Process improvement is needed to direct appropriate patients to TCHs.

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Section: Discussionmentioning

confidence: 99%

Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement

et al. 2020

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“…For instance, the availability of IVT has to be expanded beyond the main large cities to smaller cities, islands and rural areas by developing stroke-oriented and efficient transfer protocols, by emergency medical services and telestroke facilities focused on efficient recognition and fast triage of eligible candidates for IVT. 23 , 24 Finally, a media campaign, aimed to enhance public awareness on stroke symptoms and the beneficial effects of timely reperfusion, 25 , 26 would definitely increase acute reperfusion treatment rates in Greece.…”

Section: Discussionmentioning

confidence: 99%

Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience

Tsivgoulis

Kargiotis

Rudolf

et al. 2018

Ther Adv Neurol Disord

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Background:Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset.Methods:All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety and efficacy outcomes were assessed comparatively with previously published data from SITS national and international registries.Results:A total of 523 AIS patients were treated with IVT in 12 Greek centers participating in the SITS-ISTR during the study period (mean age 62.4 ± 12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150 min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5 (IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were 66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with available data from SITS-ISTR in other European countries.Conclusions:Our study underscores the safety and efficacy of IVT for AIS in Greece. Additional action is necessary in order to increase the availability of IVT in the Greek population and to include more centers in the SITS-ISTR.

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“…The predominant model for stroke systems of care uses a ‘centripetal’ model of spoke-and-hub care,15 16 where patients enter the hospital-based care system at a first-line hospital and are then transferred to a neurointerventional-capable ‘comprehensive’ center. Transfer times, however, are not insignificant, and averaged 100 min in the SWIFT-PRIME trial,6 which may result in brain loss and worsened outcomes.…”

Section: Discussionmentioning

confidence: 99%

Helistroke: neurointerventionalist helicopter transport for interventional stroke treatment: proof of concept and rationale

Hui

Mekabaty

Schultz

et al. 2017

J NeuroIntervent Surg

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Improving Transfer Times for Acute Ischemic Stroke Patients to a Comprehensive Stroke Center

Cited by 26 publications

References 15 publications

Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement

Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement

Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience

Helistroke: neurointerventionalist helicopter transport for interventional stroke treatment: proof of concept and rationale

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