Abstract 213: Stroke Severity Adjusted EMS Triage Has Benefits for Bypassed Primary Stroke Centers

Abstract

Background: Stroke Severity Adjusted EMS triage (SSAET) has been recommended to bypass Primary Stroke Centers (PSC) and transport acute severe strokes to Comprehensive Stroke Centers (CSC) for Neurosurgery, endovascular intervention and research to develop new treatments. There is increased emphasis on hospitals' stroke major complication and mortality rates. Some Hospitalists are reluctant to admit Intracerebral hemorrhage (ICH) patients without in house Neurosurgery coverage. Outcome differences of directly admitted PSC and bypassed CSC patients have not yet been described. Methods: Florida Hospital Stroke Program requests Seminole County EMS use SSAETbypass of Florida Hospital Altamonte PSC to transport acute severe stroke 9.1 miles away to Florida Hospital Orlando CSC. We retrospectively analyzed 310 suspected acute severe strokes/Transient Ischemic attacks(TIA) EMS bypassed to the CSC from 2006 to 2012 and 643 strokes/TIA's transported directly to the PSC. Differences inLength of stay (LOS), frequency of in-hospital mortality/discharge to hospice and major complications (respiratory failure, infection, DVT, PE, MI or recurrent stroke in house) were calculated. Results: The PSC lost an average of 3.69 patients to the CSC each month. The 5.52 day PSC patient average LOS was similar to the bypassed CSC patient 6.00 day LOS. Approximately 1 of every 8 bypassed CSC patients (39 of 310) received Neurosurgery or Endovascular intervention not available at the PSC. Comparing PSC patients to a subset of 209 verified stroke/TIA bypassed CSC patients showed the PSC was 15 times less likely to admit a ICH that dies in hospital or is discharged to hospice (0.6%, 4 of 643) than to be bypassed with such a patient (9.6%, 20 of 209), Odds ratio =15.38, 95% CI =5.2 to 45.5, P<0.0001. The PSC was less likely to admit any stroke (ICH or ischemic) that suffered a major complication (13%, 71 of 643) than to be bypassed with such a patient (34%, 81 of 209), Odds ratio =2.54, 95% CI =1.78 - 3.62, P<0.0001. Conclusion: SSAET bypass was especially effective for diverting fatal ICH away from a PSC without in house Neurosurgery. The bypassed PSC was less likely to admit a strokepatient with a major complication.