Response by Boulouis and Schwamm to Letter Regarding Article, “Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers”
We thank Gross et al for their thoughtful comments and think we share many of the concerns raised in their letter. The authors present their view that a policy requiring pretransfer vascular imaging would promote a decline rather than improvement in the efficient triage of and timely access to endovascular thrombectomy (EVT) for stroke patients with suspected large vessel occlusion. It is abundantly clear that timely and efficient access to EVT is a high priority for all eligible patients.
However, in resource-constrained healthcare environments, it is critical to consider all performance characteristics of a screening test when triaging patients for a time-critical treatment of proven efficacy when the consequences of not treating eligible patients is so profound. Selecting potentially EVT-eligible subjects by using National Institutes of Health Stroke Scale (NIHSS) threshold and noncontrast computed tomography (CT) alone will increase sensitivity and frequency of transfers, and likely shorten the time to EVT for treated patients, but may also amplify the cost, inconvenience, and potential harm to the many subjects who will turn out not to be EVT-eligible on arrival. It will also reduce emergency medical …