Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study

Brian S. Katz, Opeolu Adeoye, Heidi Sucharew, Joseph P. Broderick, Jason McMullan, Pooja Khatri, Michael Widener, Kathleen S. Alwell, Charles J. Moomaw, Brett M. Kissela, Matthew L. Flaherty, Daniel Woo, Simona Ferioli, Jason Mackey, Sharyl Martini, Felipe De Los Rios La Rosa, Dawn O. Kleindorfer

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background and Purpose-The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown. Methods-Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1.3 million. Addresses of all patients' residences and hospitals were geocoded, and estimated travel times were calculated. We estimated the mean differences between the travel time for patients taken to an ASRH/PSC and the theoretical time had they been transported directly to the region's CSC. Results-Of 929 patients with geocoded addresses, 806 were transported via Emergency Medical Service directly to an ASRH/PSC. Mean additional travel time of direct transport to the CSC, compared with transport to an ASRH/PSC, was 7.9±6.8 minutes; 85% would have ≤15 minutes added transport time. Triage of all stroke patients to the CSC would have added 727 patients to the CSC's census in 2010. Limiting triage to the CSC to patients with National Institutes of Health Stroke Scale score of ≥10 within 6 hours of onset would have added 116 patients (2.2 per week) to the CSC's annual census. Conclusions-Emergency Medical Service triage to CSCs based on stroke severity and symptom duration may be feasible. The impact on stroke systems of care and patient outcomes remains to be determined and requires prospective evaluation.

Original languageEnglish (US)
Pages (from-to)2164-2170
Number of pages7
JournalStroke
Volume48
Issue number8
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Urban Population
Triage
Emergency Medical Services
Stroke
Censuses
Geographic Mapping

Keywords

  • Emergency Medical Services
  • hospitals
  • stroke
  • triage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Katz, B. S., Adeoye, O., Sucharew, H., Broderick, J. P., McMullan, J., Khatri, P., ... Kleindorfer, D. O. (2017). Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study. Stroke, 48(8), 2164-2170. https://doi.org/10.1161/STROKEAHA.116.015971

Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers : An Urban Population-Based Study. / Katz, Brian S.; Adeoye, Opeolu; Sucharew, Heidi; Broderick, Joseph P.; McMullan, Jason; Khatri, Pooja; Widener, Michael; Alwell, Kathleen S.; Moomaw, Charles J.; Kissela, Brett M.; Flaherty, Matthew L.; Woo, Daniel; Ferioli, Simona; Mackey, Jason; Martini, Sharyl; De Los Rios La Rosa, Felipe; Kleindorfer, Dawn O.

In: Stroke, Vol. 48, No. 8, 01.08.2017, p. 2164-2170.

Research output: Contribution to journalArticle

Katz, BS, Adeoye, O, Sucharew, H, Broderick, JP, McMullan, J, Khatri, P, Widener, M, Alwell, KS, Moomaw, CJ, Kissela, BM, Flaherty, ML, Woo, D, Ferioli, S, Mackey, J, Martini, S, De Los Rios La Rosa, F & Kleindorfer, DO 2017, 'Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study', Stroke, vol. 48, no. 8, pp. 2164-2170. https://doi.org/10.1161/STROKEAHA.116.015971
Katz, Brian S. ; Adeoye, Opeolu ; Sucharew, Heidi ; Broderick, Joseph P. ; McMullan, Jason ; Khatri, Pooja ; Widener, Michael ; Alwell, Kathleen S. ; Moomaw, Charles J. ; Kissela, Brett M. ; Flaherty, Matthew L. ; Woo, Daniel ; Ferioli, Simona ; Mackey, Jason ; Martini, Sharyl ; De Los Rios La Rosa, Felipe ; Kleindorfer, Dawn O. / Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers : An Urban Population-Based Study. In: Stroke. 2017 ; Vol. 48, No. 8. pp. 2164-2170.
@article{47613cb8aa1543e896a0ef2a4189cfe1,
title = "Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study",
abstract = "Background and Purpose-The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown. Methods-Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1.3 million. Addresses of all patients' residences and hospitals were geocoded, and estimated travel times were calculated. We estimated the mean differences between the travel time for patients taken to an ASRH/PSC and the theoretical time had they been transported directly to the region's CSC. Results-Of 929 patients with geocoded addresses, 806 were transported via Emergency Medical Service directly to an ASRH/PSC. Mean additional travel time of direct transport to the CSC, compared with transport to an ASRH/PSC, was 7.9±6.8 minutes; 85{\%} would have ≤15 minutes added transport time. Triage of all stroke patients to the CSC would have added 727 patients to the CSC's census in 2010. Limiting triage to the CSC to patients with National Institutes of Health Stroke Scale score of ≥10 within 6 hours of onset would have added 116 patients (2.2 per week) to the CSC's annual census. Conclusions-Emergency Medical Service triage to CSCs based on stroke severity and symptom duration may be feasible. The impact on stroke systems of care and patient outcomes remains to be determined and requires prospective evaluation.",
keywords = "Emergency Medical Services, hospitals, stroke, triage",
author = "Katz, {Brian S.} and Opeolu Adeoye and Heidi Sucharew and Broderick, {Joseph P.} and Jason McMullan and Pooja Khatri and Michael Widener and Alwell, {Kathleen S.} and Moomaw, {Charles J.} and Kissela, {Brett M.} and Flaherty, {Matthew L.} and Daniel Woo and Simona Ferioli and Jason Mackey and Sharyl Martini and {De Los Rios La Rosa}, Felipe and Kleindorfer, {Dawn O.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1161/STROKEAHA.116.015971",
language = "English (US)",
volume = "48",
pages = "2164--2170",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers

T2 - An Urban Population-Based Study

AU - Katz, Brian S.

AU - Adeoye, Opeolu

AU - Sucharew, Heidi

AU - Broderick, Joseph P.

AU - McMullan, Jason

AU - Khatri, Pooja

AU - Widener, Michael

AU - Alwell, Kathleen S.

AU - Moomaw, Charles J.

AU - Kissela, Brett M.

AU - Flaherty, Matthew L.

AU - Woo, Daniel

AU - Ferioli, Simona

AU - Mackey, Jason

AU - Martini, Sharyl

AU - De Los Rios La Rosa, Felipe

AU - Kleindorfer, Dawn O.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background and Purpose-The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown. Methods-Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1.3 million. Addresses of all patients' residences and hospitals were geocoded, and estimated travel times were calculated. We estimated the mean differences between the travel time for patients taken to an ASRH/PSC and the theoretical time had they been transported directly to the region's CSC. Results-Of 929 patients with geocoded addresses, 806 were transported via Emergency Medical Service directly to an ASRH/PSC. Mean additional travel time of direct transport to the CSC, compared with transport to an ASRH/PSC, was 7.9±6.8 minutes; 85% would have ≤15 minutes added transport time. Triage of all stroke patients to the CSC would have added 727 patients to the CSC's census in 2010. Limiting triage to the CSC to patients with National Institutes of Health Stroke Scale score of ≥10 within 6 hours of onset would have added 116 patients (2.2 per week) to the CSC's annual census. Conclusions-Emergency Medical Service triage to CSCs based on stroke severity and symptom duration may be feasible. The impact on stroke systems of care and patient outcomes remains to be determined and requires prospective evaluation.

AB - Background and Purpose-The American Stroke Association recommends that Emergency Medical Service bypass acute stroke-ready hospital (ASRH)/primary stroke center (PSC) for comprehensive stroke centers (CSCs) when transporting appropriate stroke patients, if the additional travel time is ≤15 minutes. However, data on additional transport time and the effect on hospital census remain unknown. Methods-Stroke patients ≥20 years old who were transported from home to an ASRH/PSC or CSC via Emergency Medical Service in 2010 were identified in the Greater Cincinnati area population of 1.3 million. Addresses of all patients' residences and hospitals were geocoded, and estimated travel times were calculated. We estimated the mean differences between the travel time for patients taken to an ASRH/PSC and the theoretical time had they been transported directly to the region's CSC. Results-Of 929 patients with geocoded addresses, 806 were transported via Emergency Medical Service directly to an ASRH/PSC. Mean additional travel time of direct transport to the CSC, compared with transport to an ASRH/PSC, was 7.9±6.8 minutes; 85% would have ≤15 minutes added transport time. Triage of all stroke patients to the CSC would have added 727 patients to the CSC's census in 2010. Limiting triage to the CSC to patients with National Institutes of Health Stroke Scale score of ≥10 within 6 hours of onset would have added 116 patients (2.2 per week) to the CSC's annual census. Conclusions-Emergency Medical Service triage to CSCs based on stroke severity and symptom duration may be feasible. The impact on stroke systems of care and patient outcomes remains to be determined and requires prospective evaluation.

KW - Emergency Medical Services

KW - hospitals

KW - stroke

KW - triage

UR - http://www.scopus.com/inward/record.url?scp=85023740235&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85023740235&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.116.015971

DO - 10.1161/STROKEAHA.116.015971

M3 - Article

C2 - 28701576

AN - SCOPUS:85023740235

VL - 48

SP - 2164

EP - 2170

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 8

ER -