Increased Access to and Use of Endovascular Therapy Following Implementation of a 2-Tiered Regional Stroke System

被引：15

作者：

Bosson, Nichole ^{[1
,2
,3
,4
]}

Gausche-Hill, Marianne ^{[1
,2
,3
,4
]}

Saver, Jeffrey L. ^{[4
,5
]}

Sanossian, Nerses ^{[6
]}

Tadeo, Richard ^{[3
]}

Clare, Christine ^{[3
]}

Perez, Lorrie ^{[3
]}

Williams, Michelle ^{[3
]}

Rasnake, Sara ^{[3
]}

Phuong-Lan Nguyen ^{[3
]}

机构：

[1] Harbor UCLA Med Ctr, Dept Emergency Med, Torrance, CA 90509 USA

[2] Lundquist Inst, Torrance, CA USA

[3] Los Angeles Cty Emergency Med Serv Agcy, Santa Fe Springs, CA USA

[4] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA

[5] UCLA Med Ctr, Ronald Reagan, Los Angeles, CA USA

[6] Keck Univ, Sch Med, USC, Los Angeles, CA USA

来源：

STROKE | 2020年 / 51卷 / 03期

关键词：

Emergency Medical Services; neuron; odds ratio; reperfusion; thrombectomy; ACUTE ISCHEMIC-STROKE; TIME; THROMBECTOMY; REPERFUSION; MANAGEMENT; THROMBOLYSIS; OUTCOMES;

D O I：

10.1161/STROKEAHA.119.027756

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-We quantified population access to endovascular-capable centers, timing, and rates of thrombectomy in Los Angeles County before and after implementing 2-tiered routing in a regional stroke system of care. Methods-In 2018, the Los Angeles County Emergency Medical Services Agency implemented transport of patients with suspected large vessel occlusions identified by Los Angeles Motor Scale >= 4 directly to designated endovascular-capable centers. We calculated population access to a designated endovascular-capable center within 30 minutes comparing 2016, before 2-tiered system planning began, to 2018 after implementation. We analyzed data from stroke centers in the region from 1 year before and after implementation to delineate changes in rates and speed of administration of tPA (tissue-type plasminogen activator) and thrombectomy and frequency of interfacility transfer. Results-With implementation of the 2-tier system, certified endovascular-capable hospitals increased from 4 to 19 centers, and within 30-minute access to endovascular care for the public in Los Angeles County, from 40% in 2016 to 93% in 2018. Comparing Emergency Medical Services-transported stroke patients in the first post-implementation year (N=3303) with those transported in the last pre-implementation year (N=3008), age, sex, and presenting deficit severity were similar. The frequency of thrombolytic therapy increased from 23.8% to 26.9% (odds ratio, 1.2 [95% CI, 1.05-1.3]; P=0.006), and median first medical contact by paramedic-to-needle time decreased by 3 minutes ([95% CI, 0-5] P=0.03). The frequency of thrombectomy increased from 6.8% to 15.1% (odds ratio, 2.4 [95% CI, 2.0-2.9]; P<0.0001), although first medical contact-to-puncture time did not change significantly, median decrease of 8 minutes ([95% CI, -4 to 20] P=0.2). The frequency of interfacility transfers declined from 3.2% to 1.0% (odds ratio, 0.3 [95% CI, 0.2-0.5]; P<0.0001). Conclusions-After implementation of 2-tiered stroke routing in the most populous US county, thrombectomy access increased to 93% of the population, and the frequency of thrombectomy more than doubled, whereas interfacility transfers declined.

引用

页码：908 / 913

页数：6

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