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Evaluating Transport Strategies and Local Hospital Impact on Stroke Outcomes: A RACECAT Trial Substudy.

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Direct transport to specialized stroke centers may improve outcomes for patients with large-vessel occlusion, especially when local hospitals have telestroke capabilities or longer door-to-needle times. This optimizes stroke care strategies.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Health Services Research

Background:

  • Optimal patient transfer strategies to specialized acute stroke care are debated.
  • This study analyzes factors influencing transport decisions and stroke outcomes.

Purpose of the Study:

  • To investigate the impact of local hospital characteristics and performance on stroke transport strategies and patient outcomes.
  • To evaluate factors associated with functional outcomes in patients treated at local stroke centers versus thrombectomy-capable centers.

Main Methods:

  • Secondary post hoc analysis of the RACECAT trial data.
  • Assessed 90-day modified Rankin Scale scores, door-to-needle times, and local stroke center (Local-SC) level of care (telestroke vs. primary stroke center).
  • Subgroup analyses included physician specialty and Local-SC case volume.

Main Results:

  • Door-to-needle time and Local-SC level of care influenced 90-day outcomes.
  • Direct transport to thrombectomy-capable centers showed a trend toward benefit when the Local-SC was a telestroke center or had longer door-to-needle times.
  • This benefit was more pronounced in patients with confirmed large-vessel occlusion.

Conclusions:

  • Direct transport to thrombectomy-capable centers may be preferable for patients treated by telestroke or underperforming Local-SCs.
  • Findings support refining prehospital triage and optimizing stroke systems of care.
  • Special consideration for large-vessel occlusion patients is warranted.