Background: Recent guidelines recommend thrombectomy to treat stroke due to large vessel occlusions within first six hours after onset stroke time. There is no age limit, however elderly patients (>=80 years old) transferred from community hospital (CH) to comprehensive stroke center (CSC) possibly present different radiological findings in comparison with younger patients, that finally exclude them of endovascular treatment and could avoid unnecessary transfers to CSC.
Method: We reviewed consecutive patients transferred from five CH to our CSC from January 2012 to July 2016. We analyzed radiological findings in ASPECTS (Alberta Stroke Program Early CT Scale) and segment of occluded artery in NonContrastCT (NCCT) and CT-angiography, both realized in CH (pre-transfer) and CSC. We evaluated the changes in NCCT between both centers related to onset stroke time, time of transfer, vascular occlusion segment and other epidemiological variables.
Results: A total of 3825 patients were evaluated in our CSC as stroke code (24% elderly and increasing annually); 21% were transferred from CH to CSC with large vessel occlusion diagnosis and NIHSS>8. Subgroup of elderly patients presented worse score in ASPECTS-NCCT evaluated at CSC previous to endovascular treatment than younger patients (mean 6.8 vs 8.4;p: 0.001). An ASPECT score <8 in NCCT performed at CH pre-transfer was significant associated to important ASPECT score decay of respective NCCT performed at CSC for endovascular treatment assessment. This age-association was not demonstrated in younger patients. The occluded segments TICA and M1 were associated to lower ASPECTS. As a result less than 30% elderly patients transferred to CSC for thrombectomy were treated due to low ASPECT score in NCCT performed in CSC; confirmed by CT-perfusion. In ROC analysis we found a cut-off of 83 years for patients with good ASPECTS (dichotomized as ASPECTS>6) in NCCT at CSC (AUC: 0.69; S: 61%, E: 85%).
Conclusions: Patients over 83 years old and low score in ASPECT (score<8) evaluated in CH presents low benefit when they are transferred to CSC in our area. Criteria to transfer elderly patient from CH to CSC for possible endovascular treatment must be reviewed according new guidelines to get efficient our Emergency Departments.