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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Stavros Matsoukas, Brian Giovanni, Liorah Rubinstein, Shahram Majidi, Laura K. Stein, Johanna T. Fifi
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	large vessel occlusion stroke triage scale intravenous thrombolysis mothership cohort drip and ship cohort bypass model Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5ebb781887d94dd5be7e0acef6869035
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:5ebb781887d94dd5be7e0acef6869035
record_format	dspace
spelling	oai:doaj.org-article:5ebb781887d94dd5be7e0acef68690352021-12-02T12:40:23ZModeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort1664-545610.1159/000520078https://doaj.org/article/5ebb781887d94dd5be7e0acef68690352021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/520078https://doaj.org/toc/1664-5456Objective: 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.Stavros MatsoukasBrian GiovanniLiorah RubinsteinShahram MajidiLaura K. SteinJohanna T. FifiKarger Publishersarticlelarge vessel occlusionstroke triage scaleintravenous thrombolysismothership cohortdrip and ship cohortbypass modelDiseases of the circulatory (Cardiovascular) systemRC666-701ENCerebrovascular Diseases Extra, Vol 11, Iss 3, Pp 137-144 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	large vessel occlusion stroke triage scale intravenous thrombolysis mothership cohort drip and ship cohort bypass model Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	large vessel occlusion stroke triage scale intravenous thrombolysis mothership cohort drip and ship cohort bypass model Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	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_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_sort	modeling the impact of prehospital triage on a true-life drip and ship mechanical thrombectomy urban patient cohort
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/5ebb781887d94dd5be7e0acef6869035
work_keys_str_mv	AT stavrosmatsoukas modelingtheimpactofprehospitaltriageonatruelifedripandshipmechanicalthrombectomyurbanpatientcohort AT briangiovanni modelingtheimpactofprehospitaltriageonatruelifedripandshipmechanicalthrombectomyurbanpatientcohort AT liorahrubinstein modelingtheimpactofprehospitaltriageonatruelifedripandshipmechanicalthrombectomyurbanpatientcohort AT shahrammajidi modelingtheimpactofprehospitaltriageonatruelifedripandshipmechanicalthrombectomyurbanpatientcohort AT laurakstein modelingtheimpactofprehospitaltriageonatruelifedripandshipmechanicalthrombectomyurbanpatientcohort AT johannatfifi modelingtheimpactofprehospitaltriageonatruelifedripandshipmechanicalthrombectomyurbanpatientcohort
_version_	1718393739819352064

Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort

Ejemplares similares