Introduction: There is overwhelming evidence that endovascular treatment is beneficial for most acute stroke patients suffering a large vessel occlusion (LVO). It is also clear that all revascularization strategies are strongly time-dependent. Endovascular treatment is unavailable at most stroke-ready hospitals, and efficient transfer of these patients is increasingly important. We sought to assess the time to treatment for patients transferred from regional hospitals, vs. patients arriving directly at our CSC.
Methods: We evaluated the treatment times for the last 20 patients that received both IV tPA and endovascular treatment at our center. IV tPA could have been administered at the regional hospital, but all patients received endovascular treatment at the CSC. We evaluated common stroke quality metrics, plus transfer time for patients coming from another hospital. We measured transfer time as the length of time between acceptance of the patient and patient arrival to the CSC.
Results: We evaluated the most recent 20 patients receiving IV tPA and endovascular treatment since the new endovascular trials had been published. There were 6 patients undergoing interhospital transfer (IHT), and 14 that presented directly to the CSC. Door to tPA times were 93 minutes at regional hospitals vs. 56 minutes at the CSC. Door to groin puncture did not differ between the two groups. Time from symptom onset to groin puncture was significantly longer in the IHT patients - 287 minutes vs. 195 minutes. This difference was accounted for by transfer time, which averaged 126 minutes and was significantly affected by delays between transfer acceptance to the CSC and regional hospitals calling for transport, which averaged 47 minutes (range 0-141 minutes).
Conclusions: Patients with acute LVO were treated later if they underwent IHT rather than presenting directly to a CSC. Transfer from regional hospitals was slow, averaging 126 minutes. The transfer time was strongly affected by delays in arranging for transportation, which averaged 47 minutes. Transportation planning is thus a clear target for improving IHT times. Furthermore, as patients presenting directly to the CSC were treated faster, the possibility of taking severe stroke patients directly to a CSC should be studied.