Abstract W MP73: EMS Triage of Stroke Patients by Stroke Severity: Estimated Impact and Call to Action
Background: Severely affected stroke patients in most U.S. communities are often brought to the nearest or requested community hospital rather than to a comprehensive stroke center. We hypothesized that the additional time to transport these severely affected stroke patients directly to a comprehensive stroke center rather than to a nearby community hospital within the Greater Cincinnati/Northern Kentucky (GCNK) Region would be less than a mean of 15 minutes.
Methods: We included all stroke subjects in the GCNK region during 2005 who were >= age 20, had a documented time of symptom onset, were transported by EMS, lived at home, and had their stroke at home. Pt home addresses and hospitals were geocoded and travel time estimated using road class speed limits for the route with the shortest driving time to the presenting hospital as well as the comprehensive stroke center. The estimated baseline NIHSS was abstracted from hospital medical records and severe strokes were defined as an estimated NIHSS >=15.
Results: Of 2628 hospitalized stroke subjects during 2005, 1019 arrived by EMS of which 469 had a clearly documented time of stroke onset. Of these, 348 occurred at home. Of the 348, 8 could not be geocoded. Of the remaining 340 subjects, 90 (26%) had an NIHSS >=15. The types of strokes and estimated travel times for these 340 subjects are listed in the Table below.
Conclusions: Within the GCNK region, triage of severe stroke patients by EMS personnel from a patient’s home to a comprehensive stroke center, rather than to a nearby or requested community hospital, would add only an average of 6 additional minutes in travel time and would have little effect upon start of IV t-PA therapy. Such triage of stroke patients transported by EMS would facilitate rapid interventional therapy for severe ischemic strokes and assessment, treatment, and neurocritical critical care for ICH and SAH
Author Disclosures: J.P. Broderick: Research Grant; Modest; PRISMS Trial - Genentech. Honoraria; Modest; Boehringer Ingelheim. Consultant/Advisory Board; Modest; Pfizer. Other Research Support; Significant; Study medication for IMS III Trial Genentech. H. Sucharew: None. K.A. Alwell: None. B.M. Kissela: None. J. Khoury: None. D. Woo: None. O. Adeoye: None. M.L. Flaherty: None. P. Khatri: Research Grant; Modest; Dr. Khatri’s Dept of Neurology receives support for her role DSMB member from Biogen, Inc.. Research Grant; Significant; Dr. Khatri’s Dept of Neurology receives support for her roles as: (1) Lead PI of the PRISMS trial from Genentech, Inc and (2) Neurology PI of the THERAPY trial from Penumbra, Inc.. S. Ferioli: None. C.J. Moomaw: None. D. Kleindorfer: None.
- © 2015 by American Heart Association, Inc.