Regional Stroke Triage by EMS Ups Endovascular Therapy Rate

Implementation of a regional prehospital transport policy for comprehensive stroke center triage may result in a significant increase in endovascular therapy (EVT) rates among patients with acute ischemic stroke and large vessel occlusion (LVO), according to a study published online Aug. 9 in JAMA Neurology.

Tareq Kass-Hout, M.D., from the University of Chicago Pritzker School of Medicine, and colleagues evaluated the impact of a regional prehospital transport policy that directly triages patients with suspected LVO stroke to the nearest comprehensive stroke center on EVT rates. The analysis included 7,709 patients with acute ischemic stroke (AIS) arriving at 15 primary stroke centers and eight comprehensive stroke centers in Chicago, via emergency medical services (EMS) transport before and after the transport policy (Dec. 1, 2017, to May 31, 2019).

The researchers found that the EVT rate increased overall among all patients with AIS (preimplementation, 4.9 percent; postimplementation, 7.4 percent) and among EMS-transported patients with AIS within six hours of onset (preimplementation, 4.8 percent; postimplementation, 13.6 percent). In an interrupted time series analysis among EMS-transported patients, the level change within one month of implementation was 7.15 percent, but there was no slope change before or after, indicating a step rather than gradual change.

"Implementation of a prehospital transport policy for comprehensive stroke center triage in Chicago was associated with a significant, rapid, and sustained increase in EVT rate for patients with AIS without deleterious associations with thrombolysis rates or times," the authors write.