Details

Autor(en) / Beteiligte

• Bosson, Nichole
• Gausche-Hill, Marianne
• Saver, Jeffrey L
• Sanossian, Nerses
• Tadeo, Richard
• Clare, Christine
• Perez, Lorrie
• Williams, Michelle
• Rasnake, Sara
• Nguyen, Phuong-Lan
• Taqui, Asif
• Evans-Cobb, Cheryl
• Gaffney, Denise
• Duckwiler, Gary
• Ganguly, Gautam
• Sung, Gene
• Kaufman, Helaine
• Rokos, Ivan
• Tarpley, Jason
• Anotado, Jennifer
• Nour, May
• Jocson, Michelle
• Ramezan, Nima
• Patel, Nirav
• Lyden, Patrick
• Jahan, Reza
• Burrus, Tamika
• Mack, William
• Ajani, Zahra

Titel

Increased Access to and Use of Endovascular Therapy Following Implementation of a 2-Tiered Regional Stroke System

Ist Teil von

• Stroke (1970), 2020-03, Vol.51 (3), p.908-913

Ort / Verlag

United States: American Heart Association, Inc

Erscheinungsjahr

2020

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• BACKGROUND AND PURPOSE—We quantified population access to endovascular-capable centers, timing, and rates of thrombectomy in Los Angeles County before and after implementing 2-tiered routing in a regional stroke system of care. METHODS—In 2018, the Los Angeles County Emergency Medical Services Agency implemented transport of patients with suspected large vessel occlusions identified by Los Angeles Motor Scale ≥4 directly to designated endovascular-capable centers. We calculated population access to a designated endovascular-capable center within 30 minutes comparing 2016, before 2-tiered system planning began, to 2018 after implementation. We analyzed data from stroke centers in the region from 1 year before and after implementation to delineate changes in rates and speed of administration of tPA (tissue-type plasminogen activator) and thrombectomy and frequency of interfacility transfer. RESULTS—With implementation of the 2-tier system, certified endovascular-capable hospitals increased from 4 to 19 centers, and within 30-minute access to endovascular care for the public in Los Angeles County, from 40% in 2016 to 93% in 2018. Comparing Emergency Medical Services–transported stroke patients in the first post-implementation year (N=3303) with those transported in the last pre-implementation year (N=3008), age, sex, and presenting deficit severity were similar. The frequency of thrombolytic therapy increased from 23.8% to 26.9% (odds ratio, 1.2 [95% CI, 1.05–1.3]; P=0.006), and median first medical contact by paramedic-to-needle time decreased by 3 minutes ([95% CI, 0–5] P=0.03). The frequency of thrombectomy increased from 6.8% to 15.1% (odds ratio, 2.4 [95% CI, 2.0–2.9]; P<0.0001), although first medical contact-to-puncture time did not change significantly, median decrease of 8 minutes ([95% CI, −4 to 20] P=0.2). The frequency of interfacility transfers declined from 3.2% to 1.0% (odds ratio, 0.3 [95% CI, 0.2–0.5]; P<0.0001). CONCLUSIONS—After implementation of 2-tiered stroke routing in the most populous US county, thrombectomy access increased to 93% of the population, and the frequency of thrombectomy more than doubled, whereas interfacility transfers declined.