Abstract WP294: Ems Telehealth Triage by the Neurointerventionalist and Limited Non Contrast Ct Triage Shorten Hospital Process and Increase Treatment Rates for Mechanical Thrombectomy

Abstract

Background: Rapid Mechanical thrombectomy (MT) has been associated with improved clinical outcomes, and significant reductions in the hospital arrival to skin puncture interval have been achieved since publication of the 5 seminal MT trials. The benefit of advanced imaging has been questioned, especially for patients arriving within 6 hours from symptom onset. Method: After a successful pilot, 2 of the 4 endovascular capable hospitals in our network in an urban South Florida region transitioned to prehospital triage through telehealth evaluation at the scene with emergency medical services directly by the neurointerventionalist (NI) for patients with score based clinical high probability of Large Vessel Occlusion (LVO). The NI could then activate the NI team at his discretion prior to hospital arrival, if sufficient clinical markers for LVO were felt to be present. Also, a streamlined CT imaging protocol consisting only of non-contrast CT and direct transport to the NIR suite for patients deemed appropriate was instituted (Group A). The other 2 hospitals continued the prior CTA and CTP based triage protocol in all patients with activation of the NI team by the emergency room physician (Group B). Results: A total of 320 patients underwent MT between 1/2017 and 4/2018, of which 142 patients were treated in the centers which had adopted the streamlined process (Group A), and 178 in centers which utilized CTA and CTP based triage (Group B). The median Door to Puncture interval (DTG) was 62 minutes in Group A compared to 54 minutes (p<0.05) in Group B. In Group 39.7% of MT patients had a DTG ≤45mins and 19.1% ≤30 mins, compared to 29.2% and 12.9%, respectively. The rate of symptomatic hemorrhage (sICH) was numerically lower in hospitals Group A (NS). The proportion of all ischemic stroke patients treated with MT increased to 21.4% in Group A compared to 12.6% in hospitals Group B (p<0.05). Conclusion: Direct Telehealth EMS triage by the Neurointerventionalist, along with a streamlined imaging protocol can significantly decrease time to puncture and increase utilization of and access to MT without associated increased risk of sICH.