Triaging Individuals With Stroke Directly to Level 1 Stroke Centers Reduces Time to Treatment and Improves Outcomes
The research presented today at the Society of NeuroInterventional Surgery's (SNIS) 19th Annual Meeting, and now published online in the Journal of NeuroInterventional Surgery, shows that states that use field-based stroke severity triage as part of their Emergency Medical Systems (EMS) transport protocols give severe stroke patients more rapid access to specially trained neuroendovascular care teams and lifesaving thrombectomy.
Research published in the Journal of NeuroInterventional Surgery shows individuals having a severe stroke receive faster treatment with less resulting disability when Emergency Medical Systems (EMS) use severity-based triage protocols in the field.
In the study, "Long Term Effect of Field Triage on Times to Endovascular Treatment for Emergent Large Vessel Occlusion," researchers compared stroke patients in two adjacent states over 5 1/2 years.
In the study, individuals with stroke were compared in 2 adjacent states for 5.5 years.
Both states were served by a single Level 1 (comprehensive) stroke center. After matching the patients from the two regions based on distance to the Level 1 center, time to treatment decreased by 55 minutes after implementation of severity-based triage.
Both states had a single Level 1 (comprehensive) stroke center. After matching participants in different locations based on distance from the Level 1 stroke center, time to treatment decreased by 55 minutes after implementation of severity-based triage in 1 of the 2 states.
In contrast, there was no change in time to treatment in the adjacent region with traditional EMS protocols over 5 1/2 years, despite extensive efforts to improve workflow at referring hospitals.
Although there were efforts to improve stroke workflow and referral patterns, in the other state, traditional triage protocols were used, and no change in time to treatment occurred. As a result, clinical outcomes at 90 days were significantly better in those patients who resided in the state with severity-based triage, compared with traditional EMS protocols. Participants who resided in the state with severity-based triage showed better outcomes at 90 days compared with those who were triaged using traditional EMS protocols.
"The time lost in transfer from the nearest hospital to the best-equipped facility clearly jeopardizes a patient's chance of recovery," said Mahesh Jayaraman, MD, lead author of the study, a neurointerventional radiologist and professor of diagnostic imaging, neurology and neurosurgery at Brown University, and director of the Neurovascular Center at Rhode Island Hospital. "We hope this research persuades state governments to take a close look at their stroke care protocols and implement changes to improve triage and transport."
This new study confirms previous research that individuals receiving more effective stroke care at a farther facility, versus a closer facility has better results at 90 days. It also shows the importance of in-the-field triage based on stroke severity.
Triage of severe stroke is done by EMS professionals by assessing a person's ability to squeeze and release a hand or make facial expressions on request.
As yet, less than half of the US have clear protocols for severe stroke transportation care.