Background

Prehospital identification of large vessel occlusion (LVO) stroke may expedite treatment by direct transfer to comprehensive stroke centers (CSC) with endovascular capabilities. The Cincinnati Prehospital Stroke Scale (CPSS) is currently used for prehospital stroke identification. We assessed whether CPSS-based redirection of LVO stroke directly to CSC accelerated time to endovascular treatment and improved clinical outcomes.

Methods

We conducted a retrospective analysis of all patients undergoing endovascular treatment (EVT) after either direct transport to CSC or transfer from one of the three primary stroke centers affected by the redirection protocol. Data was collected over a 16-months period, halfway through which EMS redirection of patients with CPSS 3/3 to CSC was implemented (8 months before/8 months after). EMS to door, door to needle (DTN), first door to groin puncture (DTP) and modified Rankin scores at 3 months were compared over the two periods. 

Results

Prior to implementation, 58 LVO stroke patients underwent EVT with a median (IQR) DTP of 109(64-146) minutes. Following implementation, 71 patients underwent EVT with a median (IQR) DTP of 81(56-130) minutes (difference: -28 minutes, p=0.03). Median EMS to door time increased by 4 minutes (p=0.03), median DTN time decreased by 6 minutes (p=0.06) and the proportion of patients with an mRS score of 0-2 at 3 months increased from 35% to 43% (p=0.35).

Conclusions

EMS redirection of LVO stroke directly to CSC significantly decreases time to EVT, without delaying thrombolysis. This may be a beneficial strategy to improve clinical outcomes but requires validation in larger cohorts.

EMS DIVERSION OF SUSPECTED LARGE VESSEL OCCLUSION STROKE IS ASSOCIATED WITH IMPROVED ENDOVASCULAR TREATMENT TIMES AND OUTCOMES