Introduction: Recent thrombectomy trials for emergent large vessel occlusion (ELVO) have spurred an international debate regarding the best way to get ELVO patients to the right centers quickly. Here we attempt to identify triage features associated with the best patient outcomes.
Methods: A large, multi-hospital health system Get With The Guidelines stroke registry was used to identify patients >18 years old who had intra-arterial (IA) treatment of ELVO between January 2012 and June 2016. Primary outcomes were modified Rankin score (mRS) at discharge and discharge disposition. Generalized linear regression models were used to identify which of the variables on the figure’s Y-axis were related to the outcomes.
Results: We identified 562 ELVO patients who received IA-treatment. Patients were more likely to have greater disability if they were treated at a PSC (AOR=3.14; p=.004), were a transfer (AOR = 5.18, p=.001), had a higher NIHSS score (AOR = 1.10; p<.001), were older (AOR=1.04; p=.003), or had longer Door to IA times (AOR = 1.01; p=.008). Compared to discharge to home, patients were more likely to be sent to hospice or expire if they were treated at a PSC (AOR=2.28; p=.021), were a transfer (AOR=2.39, p=.047), had a higher NIHSS (AOR=1.19; p<.001), were older (AOR = 1.06; <.001), or had longer Door to IA times (AOR = 1.01; p=.009). Patients were more likely to be sent to a SNF if they if they were a transfer (AOR = 2.70, p=.014), had a higher NIHSS score (AOR=1.13; p<.001), were older (AOR = 1.06; <.001), or had longer Door to IA times (AOR = 1.01; p=.029).
Conclusions: Being treated locally rather than transferred, at a comprehensive rather than primary stroke center, and with shorter door to IA times were the strongest drivers of good outcome. Conversely, the annual IA treatment volume was not a driver of outcome.