Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort
Objective: The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system. Methods: We selected a cohor...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Karger Publishers
2021-11-01
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| Series: | Cerebrovascular Diseases Extra |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/520078 |
| _version_ | 1818971157704998912 |
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| author | Stavros Matsoukas Brian Giovanni Liorah Rubinstein Shahram Majidi Laura K. Stein Johanna T. Fifi |
| author_facet | Stavros Matsoukas Brian Giovanni Liorah Rubinstein Shahram Majidi Laura K. Stein Johanna T. Fifi |
| author_sort | Stavros Matsoukas |
| collection | DOAJ |
| description | Objective: The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system. Methods: We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) (“actual” drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients’ initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times (“actual” mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort. Results: Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively. Conclusions: Modeled EMS prehospital triage of ELVO patients’ results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes. |
| first_indexed | 2024-12-20T14:47:55Z |
| format | Article |
| id | doaj.art-5ebb781887d94dd5be7e0acef6869035 |
| institution | Directory Open Access Journal |
| issn | 1664-5456 |
| language | English |
| last_indexed | 2024-12-20T14:47:55Z |
| publishDate | 2021-11-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Cerebrovascular Diseases Extra |
| spelling | doaj.art-5ebb781887d94dd5be7e0acef68690352022-12-21T19:37:04ZengKarger PublishersCerebrovascular Diseases Extra1664-54562021-11-0111313714410.1159/000520078520078Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient CohortStavros Matsoukas0Brian Giovanni1Liorah Rubinstein2Shahram Majidi3https://orcid.org/0000-0003-2971-6216Laura K. Stein4https://orcid.org/0000-0002-8268-616XJohanna T. Fifi5Department of Neurosurgery, The Mount Sinai Hospital, New York, NY, USADepartment of Neurosurgery, The Mount Sinai Hospital, New York, NY, USADepartment of Neurosurgery, The Mount Sinai Hospital, New York, NY, USADepartment of Neurosurgery, The Mount Sinai Hospital, New York, NY, USADepartment of Neurology, The Mount Sinai Hospital, New York, NY, USADepartment of Neurosurgery, The Mount Sinai Hospital, New York, NY, USAObjective: The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system. Methods: We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) (“actual” drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients’ initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times (“actual” mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort. Results: Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively. Conclusions: Modeled EMS prehospital triage of ELVO patients’ results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.https://www.karger.com/Article/FullText/520078large vessel occlusionstroke triage scaleintravenous thrombolysismothership cohortdrip and ship cohortbypass model |
| spellingShingle | Stavros Matsoukas Brian Giovanni Liorah Rubinstein Shahram Majidi Laura K. Stein Johanna T. Fifi Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort Cerebrovascular Diseases Extra large vessel occlusion stroke triage scale intravenous thrombolysis mothership cohort drip and ship cohort bypass model |
| title | Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort |
| title_full | Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort |
| title_fullStr | Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort |
| title_full_unstemmed | Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort |
| title_short | Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort |
| title_sort | modeling the impact of prehospital triage on a true life drip and ship mechanical thrombectomy urban patient cohort |
| topic | large vessel occlusion stroke triage scale intravenous thrombolysis mothership cohort drip and ship cohort bypass model |
| url | https://www.karger.com/Article/FullText/520078 |
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