Rapid Response System for In-Hospital Large Vessel Occlusion: A Case-Control Study

Area of Science:

• Neurology
• Emergency Medicine
• Hospital Medicine

Background:

• Large vessel occlusion (LVO) stroke in hospitalized patients is a critical condition requiring rapid intervention.
• Existing protocols for in-hospital LVO are limited, highlighting a need for improved time-saving strategies.
• Rapid Response Systems (RRS) offer a potential solution for accelerating acute stroke management within hospitals.

Purpose of the Study:

• To evaluate the efficacy of a Rapid Response System (RRS) in reducing treatment times for in-hospital large vessel occlusion (LVO) strokes.
• To compare the time metrics of stroke management with and without RRS intervention.
• To assess the validity of expanded RRS activation criteria for neurological emergencies.

Main Methods:

• Retrospective evaluation of 26 hospitalized patients with LVO undergoing mechanical thrombectomy (MT) between April 2015 and January 2020.
• Implementation of revised RRS criteria in November 2017, including specific neurological symptoms.
• Comparison of time from detection to stroke team assessment and initial CT between RRS and non-RRS groups.

Main Results:

• The RRS group demonstrated significantly shorter median times for stroke team assessment (10 vs. 65.5 minutes) and initial CT (22 vs. 46.5 minutes).
• RRS was activated in 34 patients under the revised criteria, with 58.8% diagnosed with cerebral infarction and 9 undergoing MT.
• Other RRS-activated cases frequently involved neurological emergencies requiring acute care.

Conclusions:

• Rapid Response Systems (RRS) can significantly shorten response times in managing in-hospital LVO.
• Prompt patient transport to the emergency room by a Medical Emergency Team (MET) facilitates faster stroke team intervention.
• RRS implementation, with expanded criteria, effectively addresses neurological emergencies, including LVO strokes.