TY - JOUR
T1 - Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke
AU - van Meenen, Laura C C
AU - den Hartog, Sanne J
AU - Groot, Adrien E
AU - Emmer, Bart J
AU - Smeekes, Martin D
AU - Siegers, Arjen
AU - Kommer, Geert Jan
AU - Majoie, Charles B L M
AU - Roos, Yvo B W E M
AU - van Es, Adriaan C G M
AU - Dippel, Diederik W
AU - van der Worp, H Bart
AU - Lingsma, Hester F
AU - Roozenbeek, Bob
AU - Coutinho, Jonathan M
AU - MR CLEAN Registry Investigators
AU - van Oostenbrugge, Robert Jan
AU - van Zwam, Wim
AU - Hinsenveld, Wouter
AU - Goldhoorn, Robert-Jan
AU - Staals, Julie
AU - Postma - Jacobi, Linda
N1 - © 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2021/12
Y1 - 2021/12
N2 - BACKGROUND AND PURPOSE: We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome.METHODS: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014-2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke.RESULTS: Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12-19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38-90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: -0.49 min/annual referral, 95% confidence interval [CI]: -1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: -0.34 min/annual referral, 95% CI: -0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96-1.01).CONCLUSIONS: In patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.
AB - BACKGROUND AND PURPOSE: We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome.METHODS: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014-2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke.RESULTS: Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12-19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38-90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: -0.49 min/annual referral, 95% confidence interval [CI]: -1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: -0.34 min/annual referral, 95% CI: -0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96-1.01).CONCLUSIONS: In patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.
KW - HOSPITAL CASE-VOLUME
KW - IMPACT
KW - MORTALITY
KW - OUTCOMES
KW - SURVIVAL
KW - THROMBOLYSIS VOLUME
KW - high-volume hospitals
KW - ischemic stroke
KW - low-volume hospitals
KW - thrombectomy
KW - workflow
U2 - 10.1111/ene.15107
DO - 10.1111/ene.15107
M3 - Article
C2 - 34528335
SN - 1351-5101
VL - 28
SP - 4031
EP - 4038
JO - European Journal of Neurology
JF - European Journal of Neurology
IS - 12
ER -