Abstract WP90: Upgrading To Endovascular Thrombectomy Performing Hospitals Increases Overall Acute Ischemic Stroke Admissions

Abstract

Introduction: Given the impact of endovascular therapy (EVT) on clinical outcomes and usage of pre-hospital bypass protocols to route acute ischemic stroke (AIS) patients with suspected large vessel occlusion (LVO) to EVT-performing hospitals (EPH), there is substantial interest in upgrading stroke center certification to become comprehensive centers. Here, we assess the effect of becoming EPH on total AIS and non-LVO AIS admissions in four hospitals in a large urban area. Methods: From our prospectively collected multi-institutional registry, we identified all consecutive patients with AIS at four EPHs between Nov 2017 - May 2019. Three of the EPHs (named EPH 1, EPH 2, EPH 3) became EPHs in early 2017, which allowed for preferential routing and pre-hospital bypassing of other non-EPH hospitals by regional emergency medical services protocols. Another EPH (named original EPH) had been an EPH for many years. The primary outcome was the volume of AIS admissions after upgrading to a EPH over time and was determined by linear regression. Results: Among 3,727 patients with AIS presenting to 4 hospitals across the Houston area, median age was 67 [IQR 57-78], 48% were female, median NIHSS was 5 [IQR 2-12], 21% had LVO, 11% underwent EST. AIS admissions increased at EPH 1 at a rate of 15 AIS per quarter (95% CI 5.5-25.3, p=0.012); EPH 2 increased at a rate of 8 AIS per quarter (95% CI 3.18 - 13.44, p=0.011); EPH 3 increased at a rate of 10 AIS per quarter (95% CI 2.4-18.6, p=0.023) AIS admissions at the original EPH did not change significantly during the study period (CI 0-11.9, p=0.47). Increases in AIS admissions were predominantly in non-LVO AIS (Figure A). Conclusions: In this observational cohort study, upgrading to EPH status resulted in continuously increasing AIS admissions over time, particularly for non-LVO patients; this growth was not observed in established EPH. These findings demonstrate and quantify the effect of upgrading stroke center certification on inpatient AIS volumes.