Triaging Stroke Patients Directly to Level 1 Stroke Centers Shown to Improve Outcomes

July 27, 2022—The Society of NeuroInterventional Surgery (SNIS) announced the presentation of a study that found that the use of field-based stroke severity triage as part of their emergency medical systems (EMS) transport protocols gives severe stroke patients more rapid access to specially trained neuroendovascular care teams and lifesaving thrombectomy.

The study, “Long Term Effect of Field Triage on Times to Endovascular Treatment for Emergent Large Vessel Occlusion,” was presented at the SNIS 19th annual meeting held July 25-29 in Toronto, Canada. Additionally, Mahesh V Jayaraman, MD, et al published the study online in the Journal of NeuroInterventional Surgery.

According to the SNIS press release, the study investigators compared stroke patients in two adjacent states during a period of 5.5 years. Both states were served by a single Level 1 (comprehensive) stroke center.

After matching the patients from the two regions based on the distance to the Level 1 center, the investigators found that the time to treatment decreased by 55 minutes after the implementation of severity-based triage. In contrast, there was no change in time to treatment in the adjacent region with traditional EMS protocols over 5.5 years, despite extensive efforts to improve workflow at referring hospitals. As a result, clinical outcomes at 90 days were significantly better in those patients who resided in the state with severity-based triage, compared with traditional EMS protocols.

“The time lost in transfer from the nearest hospital to the best-equipped facility clearly jeopardizes a patient’s chance of recovery,” commented Dr. Jayaraman in the SNIS press release. “We hope this research persuades state governments to take a close look at their stroke care protocols and implement changes to improve triage and transport.”

Dr. Jayaraman is a neurointerventional radiologist, Professor of Diagnostic Imaging, Neurology, and Neurosurgery at Brown University, and Director of the Neurovascular Center at Rhode Island Hospital in Providence, Rhode Island.

As noted in the SNIS press release, previous studies have shown that when patients are taken to a slightly more distant facility that is better equipped to treat them (a Level 1 stroke center), rather than simply going to the closest facility, they have been found to undergo the appropriate care more quickly and have less disability at 90 days after their stroke (Jayamaran et al, JNIS. 2020;12:233-239).

This new study confirms the previous results and shows just how critical changing EMS protocols are to a patient’s survival. Currently, less than half of the 50 states in the United States have clear protocols to ensure a patient who is having a severe stroke is transported directly to the right facility, advised SNIS.