Field triage for endovascular stroke therapy: a population-based comparison

Area of Science:

• Neurology
• Emergency Medicine
• Vascular Surgery

Background:

• Endovascular therapy (EVT) is a time-sensitive treatment for stroke.
• Optimizing patient transfer to stroke centers is crucial for improving outcomes.

Purpose of the Study:

• To compare treatment times and clinical outcomes.
• To evaluate field triage to a comprehensive stroke center (CSC) versus closest primary stroke center (PSC).

Main Methods:

• Retrospective analysis of 232 stroke patients over 2 years.
• Comparison of direct transport to PSC versus field triage to a more distant CSC.
• Matched-pairs analysis based on stroke severity and distance to CSC.

Main Results:

• Direct triage to CSC was associated with a median 7-minute increase in transport time.
• Faster times to alteplase and arterial puncture in the direct triage group (p<0.001).
• Reduced disability at 90 days for patients triaged directly to CSC (OR 1.47, p=0.003; matched pairs OR 2.06, p=0.01).

Conclusions:

• Field triage to a slightly more distant CSC improves time to EVT for eligible stroke patients.
• This strategy does not delay alteplase administration.
• Triage to CSC is associated with reduced patient disability at 90 days.