Abstract TP51: Establishing Stroke Pre-alert Criteria Reduces Delays In Endovascular Management

Abstract

Background: Mechanical thrombectomy (MT) is standard of care for patients with cerebral large vessel occlusions (LVO). Efficacy of MT depends on the timeliness of reperfusion. Establishing a pre-alert criteria to activate the stroke team prior to patient arrival in the emergency department (ED) may help rapidly identify candidates for MT. Objective: To determine whether establishment of pre-alert criteria can improve door-to-groin (DTG) and door-to-reperfusion (DTR) times. Methods: We retrospectively reviewed electronic prehospital and hospital records of stroke-alerted patients prior to (pre-protocol) and after (post-protocol) implementation of our stroke pre-alert protocol. We initiated our protocol in November 2022 to pre-alert patients that EMS found with (1) positive on Cincinnati Pre-Hospital Stroke Scale with last known well (LKW) <4.5 hours or positive CPSS and Vision-Aphasia-Neglect with LKW <24 hours, (2) Glasgow Coma Score >8, (3) glucose 60-400mg/dL, (4) systolic blood pressure >90, (5) oxygen saturation >90%, and (6) no seizures at presentation. Patients stroke-alerted in the ED prior to protocol (April 1, 2020-November 10, 2021) were historical controls. Results: EMS presented 667 (49% female) patients to our hospital, of which 195 patients arrived after pre-alert protocol initiation. Among post-protocol patients, 13.8% (27/195) underwent MT, while 11% (52/472) of pre-protocol patients underwent MT. Among patients who underwent MT, 26 post-protocol patients (96%) and 22 pre-protocol patients (42%) were pre-alerted [X 2 =21, p<0.001]. Mean DTR decreased by 63.83 minutes in post-change group [19.83-115.85]. Mean DTG decreased by 65.26 minutes in post-change group [36.54-102.90]. Conclusion: Establishment of a reasonable pre-alert criteria facilitates stroke alert activation and reduces time to MT intervention in patients presenting to the ED with an LVO. More studies are needed to determine an optimal pre-alert criteria to further reduce MT delays.