Trauma Communications Center Coordinated Severity-Based Stroke Triage: Protocol of a Hybrid Type 1...

Area of Science:

• Neurology
• Public Health
• Health Systems Research

Background:

• Mechanical thrombectomy (MT) improves outcomes for large vessel occlusion (LVO) stroke, but access is limited and inequitable.
• Current emergency medical service (EMS) protocols often delay LVO patients from reaching capable stroke centers.
• Alabama's trauma system offers a model for optimizing emergency care coordination.

Purpose of the Study:

• To develop and evaluate a severity-based stroke triage (SBST) model integrated with Alabama's trauma communications center (TCC).
• To compare the SBST pathway's effectiveness against current triage in improving access to MT.
• To assess stakeholder perceptions of the SBST model's feasibility, appropriateness, and acceptability.

Main Methods:

• A hybrid type 1 effectiveness-implementation study using a stepped wedge cluster trial design.
• Extension of TCC-guided stroke severity assessment across all Alabama EMS regions.
• Phased implementation of TCC Coordinated SBST with mixed-methods data collection (surveys, interviews, focus groups).

Main Results:

• The primary outcome is the change in the proportion of suspected LVO patients receiving MT pre- and post-SBST implementation.
• Secondary outcomes include changes in public health impact and stakeholder-reported feasibility, appropriateness, and acceptability.
• The study is powered to detect a 15% improvement in MT rates.

Conclusions:

• The trauma system infrastructure can be adapted to create a more integrated and effective emergency stroke care system.
• Successful implementation of SBST could significantly improve timely access to mechanical thrombectomy for LVO patients.
• This model has the potential to reduce disparities and improve outcomes in stroke care.