Shweta Kamat Mashni1, Charles R O'Neal2, Erin Abner3, Jessica Lee4, Justin F Fraser5. 1. College of Medicine, University of Kentucky, Lexington, Kentucky. 2. Kentucky Board of Emergency Medical Services, Lexington, Kentucky. 3. Department of Epidemiology, University of Kentucky, Lexington, Kentucky. 4. Department of Neurology, University of Kentucky, Lexington, Kentucky. 5. Department of Neurology, University of Kentucky, Lexington, Kentucky; Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky; Department of Neuroscience, University of Kentucky, Lexington, Kentucky; Department of Radiology, University of Kentucky, Lexington, Kentucky; Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky. Electronic address: jfr235@uky.edu.
Abstract
BACKGROUND: Early treatment is the key to a successful recovery for ischemic stroke patients. From time of onset, a patient's chances of permanent disability only increase until they can receive reperfusion intervention. OBJECTIVE: We sought to identify potential delays that occur during evaluation and treatment of patients in a rural regional health system. METHODS: We conducted a single-center retrospective review of all patients that arrived at our comprehensive stroke center (CSC) between July 2011 and March 2017, and received thrombectomy, with or without prior treatment with intravenous recombinant tissue plasminogen activator. RESULTS: One hundred and fifty-four patients met our criteria for inclusion. Patients were divided into 2 groups: Direct (patients brought to our CSC from scene) and Transfer (patients taken to an outside hospital then transferred to our CSC). The median time to CSC for Direct patients was 82 (range: 15-863) minutes after onset of symptoms, compared to 237 (range: 98-1215) minutes for the Transfer group. The median time for Transfer patients to reach an outside hospital was 74 (range: 5-840) minutes, with an additional average time of 90 minutes in the outside hospital prior to transferred to our CSC. CONCLUSIONS: Based on our findings, patients brought directly to our CSC saved a significant amount of time, which may improve functional outcomes. Both groups (Direct and Transfer) spent a similar amount of time between last known normal and emergency medical services arrival, highlighting the need for increased awareness among the public to activate the stroke system of care.
BACKGROUND: Early treatment is the key to a successful recovery for ischemic strokepatients. From time of onset, a patient's chances of permanent disability only increase until they can receive reperfusion intervention. OBJECTIVE: We sought to identify potential delays that occur during evaluation and treatment of patients in a rural regional health system. METHODS: We conducted a single-center retrospective review of all patients that arrived at our comprehensive stroke center (CSC) between July 2011 and March 2017, and received thrombectomy, with or without prior treatment with intravenous recombinant tissue plasminogen activator. RESULTS: One hundred and fifty-four patients met our criteria for inclusion. Patients were divided into 2 groups: Direct (patients brought to our CSC from scene) and Transfer (patients taken to an outside hospital then transferred to our CSC). The median time to CSC for Direct patients was 82 (range: 15-863) minutes after onset of symptoms, compared to 237 (range: 98-1215) minutes for the Transfer group. The median time for Transfer patients to reach an outside hospital was 74 (range: 5-840) minutes, with an additional average time of 90 minutes in the outside hospital prior to transferred to our CSC. CONCLUSIONS: Based on our findings, patients brought directly to our CSC saved a significant amount of time, which may improve functional outcomes. Both groups (Direct and Transfer) spent a similar amount of time between last known normal and emergency medical services arrival, highlighting the need for increased awareness among the public to activate the stroke system of care.
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