Timing of vessel imaging for suspected large vessel occlusions does not affect groin puncture time in transfer patients with stroke

Liang, John; Stein, Laura; Wilson, Natalie; Fifi, Johanna T; Tuhrim, Stanley; Dhamoon, Mandip S.

doi:10.1136/neurintsurg-2016-012854

Cited by 12 publications

(9 citation statements)

References 8 publications

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“…This was also the case for ambulance travel times; median ambulance travel time in our study was 19 min compared to 23–95 min in other studies [3,5,32,33,35]. Our median CSC DTGT (39 min) was within the range, although on the lower end, of previously reported median CSC DTGTs for transferred patients (35–81 min) [3,7,33]. As data for this study were collected in a country with an advanced health care system, and time intervals were relatively short compared to those found in other countries, our findings should be extrapolated to other countries with caution.…”

Section: Discussionsupporting

confidence: 79%

“…Second, data collection for our study took place in the Netherlands, which is a densely populated country in which hospitals are located relatively close to one another, and there is overall good infrastructure [31]. Furthermore, in our study, the median PSC DTGT was short (144 min) compared to existing literature, in which median PSC DTGTs ranging from 153 to 191 min have been reported [3,[32][33][34].…”

Section: Discussionmentioning

confidence: 84%

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Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Meenen

Hartog

Groot

et al. 2021

Euro J of Neurology

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Background and purpose:We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome. Methods:We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014)(2015)(2016)(2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-doorto-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke. Results: Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12-19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38-90). Eighty-three percent had received intravenous

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 84%

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Meenen

Hartog

Groot

et al. 2021

Euro J of Neurology

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“…39,40 Implementation of vascular imaging at the initial hospital and development of image sharing tools would reduce futile transfer and obviate the need for repeat imaging at the receiving facility. 41,42 Efforts at the EVT providing centers focused on improving transfer acceptance processes and innovative approaches, like interhospital transfer directly to the neuroangiography suite, have been shown to shorten reperfusion times for patients arriving by interhospital transfer. 43 The significant scope for improving efficiency in interhospital transfer was highlighted by the fact that implementation of a standardized protocol with some of the elements discussed above resulted in a 38% reduction of door-in to door-out time and doubled the likelihood of a favorable outcome for patients with suspected LVO who presented to hospitals without endovascular capability.…”

Section: Discussionmentioning

confidence: 99%

Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States

et al. 2019

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BACKGROUND: The use of endovascular therapy (EVT) in acute ischemic stroke patients with large vessel occlusion (LVO) has rapidly increased in the US following pivotal trials demonstrating its benefit. Information about the contribution of interhospital transfer in improving access to EVT will help organize regional systems of stroke care. METHODS: We analyzed trends of transfer-in EVT from a cohort of 1,863,693 ischemic stroke patients admitted to 2,143 Get With The Guidelines-Stroke participating hospitals between January 2012 and December 2017. We further examined the association between arrival mode and in-hospital outcomes using multivariable logistic regression models. RESULTS: Of the 37,260 patients who received EVT at 639 hospitals during the study period, 42.9% (15,975) arrived to the EVT providing hospital after interhospital transfer. Transfer-in EVT cases increased from 256 in Q1 2012 to 1,422 in Q4 2017, with sharply accelerated increases following Q4 2014 (p<0.001 for change in linear trend). Transfer-in patients were younger, more likely to be of white race, arrive during off-hours and treated at comprehensive stroke centers. Transfer-in patients had significantly longer last known well to EVT initiation time (median 289 min vs 213 min, absolute standardized difference 67.33) but were more likely to have door to EVT initiation time of ≤ 90 minutes (65.6% vs 23.6%, absolute standardized difference 93.18). Inhospital outcomes were worse for transfer-in EVT patients in unadjusted and in risk-adjusted

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“…One concern for obtaining a CTA at the transferring hospital is the unpredictability of acquisition and interpretation. Liang et al 12 demonstrated the feasibility of outreach efforts to improve the performance of transferring hospitals in rapidly obtaining a CTA prior to transfer. After their efforts, among 57 consecutive transfers, stroke onset to groin puncture time was similar regardless of whether CTA was done at the transferring or hospital or the endovascular-capable hospital.…”

Section: Discussionmentioning

confidence: 99%

Predictors of false-positive stroke thrombectomy transfers

Zielinski

Ouyang

et al. 2017

J NeuroIntervent Surg

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Background Most patients with large vessel occlusion (LVO) stroke need to be transferred to receive thrombectomy. To save time, the decision to transfer often relies on clinical scales as a surrogate for LVO rather than imaging. However, clinical scales have been associated with high levels of diagnostic error. The aim of this study is to define the susceptibility to overdiagnosis of our current transfer decision process by measuring the rate of non-treatment transfers, the most common reasons for no treatment and potential predictors. Methods Clinical and transfer data on consecutive patients transferred to a single endovascular capable centre for possible thrombectomy via stroke code activation were retrospectively reviewed. Whether patients underwent the procedure, why they did not undergo the procedure, and other clinical and logistical predictors were recorded. χ 2 tests and multivariate logistic regression analysis were performed.

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Timing of vessel imaging for suspected large vessel occlusions does not affect groin puncture time in transfer patients with stroke

Cited by 12 publications

References 8 publications

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States

Predictors of false-positive stroke thrombectomy transfers

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