Introduction and Hypothesis: The new emphasis placed on endovascular therapy for stroke patients suffering from a large vessel occlusion (LVO) will require enhanced EMS prehospital notification and advanced endovascular team readiness. We postulate that establishing a Stroke Control Center (SCC) will likely decrease first medical contact-to-emergency department (ED) door times in rural areas, reduce time to optimal intervention in metros, and lead to improved clinical outcomes for rural and urban communities.
Methods: A power analysis was completed using stroke records from the Georgia Coverdell Acute Stroke Registry (8258 patients from 2009-2013) in order to establish the sample size needed to produce a pilot program that could address multiple parameters and measure gains from baseline. A power of 0.90 and alpha level of 0.05 were chosen for two metrics: decreasing ED door-to needle time from 59 minutes in 2013 to 54 minutes and decreasing first medical contact-to-ED door time from 214 minutes in 2013 to 180 minutes. Modeled after Poison Control Centers, the program aims to establish an on-call SCC staffed by stroke specialists that field calls from EMS providers and deliver a mechanism for verifying LVO stroke symptoms while connecting EMS with receiving EDs. This liaison would be supported by a unique application for mobile devices that collects real-time information on both transport and clinical parameters. This data in turn would drive the choice of transport destination and alert receiving EDs so that the necessary imaging and interventional preparation could be initiated while the patient was still in transit. A training and certification program for participating EMS personnel would also be established.
Results: Results show that if ED door-to-needle time were decreased to 54 minutes a sample size of 338 patients would be sufficient to validate significance. Decreasing first medical contact-to-ED door time to 180 minutes would similarly require 1138 patients.
Conclusions: A SCC provides an achievable model to improve stroke care by reducing time to optimal treatment and can be customized to the needs of geography and patient characteristics.