Yasmin Aziz, MD
Venema E, Burke JF, Roozenbeek B, Nelson J, Lingsma HF, Dippel DWJ, Kent DM. Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States. Stroke. 2020;51:3310–3319.
Patients with acute large vessel occlusions (LVOs) have better outcomes if they are sent to the endovascular suite expeditiously. Yet, many times these patients are taken to the nearest primary stroke center under the “drip and ship” model.
In this study, the authors used geographic information, census data, and stroke center accreditor information to build an origin to destination matrix analyses of patient location to nearest primary stroke center and to nearest intervention center. To do so, four different triage strategies were compared: (1) always going directly to the nearest primary stroke center, (2) always going directly to an endovascular center; (3) using the current AHA algorithm suggesting direct transfer to endovascular center if driving time is less than 30 minutes when LVO is suspected and won’t preclude tPA administration; (4) using a modified algorithm that would allow for additional driving time if an LVO is suspected if thrombolysis isn’t precluded (adding <30 minutes of driving time, <60 minutes of driving time, or not restricting by driving time at all).