Abstract
Introduction: Comprehensive Stroke Centers are skilled, highly trained facilities that provide advanced care to an array of stroke patients. If stroke patients are not able to reach a Comprehensive Stroke Center, Primary Stroke Centers provide convenient and rapid care to patients presenting with acute ischemic stroke. Ideally, these Primary Centers save time to intervention. Whether there are differences in time to intervention, and resultant patient outcomes, between such centers has not been thoroughly studied. To this end, we examined door-to-needle and door-to-stroke alert time between one Comprehensive Stroke Center and three Primary Stroke Centers in Northwest Ohio. Hypothesis: Primary Stroke Centers will have longer time to intervention (i.e., door-to-needle times) than that of Comprehensive Stroke Centers. Methods: From 2018-2023, we examined door-to-needle and door-to-stroke alert times in patients presenting to the ProMedica Health System with ischemic stroke in a retrospective chart review. All patients presented with Large Vessel Occlusion (LVO) ischemic stroke. Results: 293 patients and 255 patients presented to either the Primary Centers or the Comprehensive Stroke Center, respectively. Door-to-needle time was significantly longer in patients presenting to the Primary Centers (Median: 59.00 minutes), compared to the Comprehensive Stroke Centers (Median: 39.50) (Mann Whitney U-Test: p <0.0001). However, door-to-stroke alert was not different between the two centers (Primary, Median: 2; Comprehensive, Median: 1, Mann Whitney U-Test: p = 0.099). Conclusions: We report a longer latency to needle in Primary Stroke Centers compared to Comprehensive Stroke Centers, with no change in door-to-stroke alert time. It is forthcoming whether this difference impacts patient outcome measures. Such findings suggest that stopping at Primary Stroke Centers may not provide either a time- or outcome-benefit in lieu of immediate arrival to a Comprehensive Stroke Center.
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