1. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis
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Alan Flores, Alvaro Garcia-Tornel, Laia Seró, Xavier Ustrell, Manuel Requena, Anna Pellisé, Paula Rodriguez, Angela Monterde, Lidia Lara, Jose María Gonzalez-de-Echavarri, Carlos A Molina, Antonio Doncel-Moriano, Laura Dorado, Pedro Cardona, David Cánovas, Jerzy Krupinski, Natalia Más, Francisco Purroy, Jose Zaragoza-Brunet, Ernesto Palomeras, Dolores Cocho, Jessica Garcia, Carla Colom, Yolanda Silva, Manuel Gomez-Cocho, Xavier Jiménez, Josep Ros-Roig, Sonia Abilleira, Natalia Pérez de la Ossa, and Marc Ribo
- Subjects
Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundThe influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI− at LSC arrival on variables related to workflows using data from the RACECAT Trial.ObjectiveTo compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition.MethodsWe included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients.ResultsAmong 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69–96) vs VI− 76 (IQR 59–98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26–53) vs VI− 54 (IQR 40–70), PConclusionAmong patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
- Published
- 2023
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