Emergency transport times for stroke patients still in need of improvement

July 27, 2015

SAN FRANCISCO, CA - July 27, 2015 - Despite efforts to close the time gap between symptom onset and stroke treatment - including improvements in public education, 911 dispatch operations, pre-hospital detection and triage, hospital stroke system development, and stroke unit management - a new study presented today at the Society of NeuroInterventional Surgery (SNIS) 12th Annual Meeting suggests that delays in emergency transport are still prevalent and that improvements are needed to ensure patients can be treated within the optimal time window.

Perhaps more than any other condition, stroke requires timely diagnosis and treatment to yield the best possible outcomes for patients. Three recent stroke studies - MR CLEAN, ESCAPE and EXTEND IA - demonstrated that the success of endovascular therapy was due in part to reducing the time it took for patients to access treatment. Evaluation of Transfer Times for Emergent Stroke Patients from Regional Centers to a Comprehensive Stroke Center, conducted at Vanderbilt University Medical Center in Nashville, Tennessee, specifically focuses on time intervals associated with hospital-to-hospital transfer as most patients in the United States (U.S.) are transported to a regional center that is not equipped to treat all levels of stroke. Recording 70 patient transfer times within a one-year timeframe, the study found that all transfer times were significantly longer than expected driving times, with average differences per hospital ranging from 46 to 133 minutes.

"Stroke requires a multi-disciplinary team that engages in a nuanced chain of events leading to treatment, and efficient and prompt patient transport via Emergency Medical Services (EMS) is a significant link in the process," said Dr. Michael Froehler, lead study author and neurointerventionalist at the Cerebrovascular Program at Vanderbilt University Medical Center. "Within the broader stroke community, we've definitely made progress in our systems of care that ensure an increasing number of patients receive treatment as quickly as possible. But we need to do more."

The conversation on time to treatment is not without precedent. Within the last decade, the American Heart Association/American Stroke Association has put forth guidelines designed to advocate that stroke patients receive the highest level of care in the shortest time possible. Many state legislatures have created stroke prevention task forces and developed state-wide stroke prevention plans. Individual counties and cities have established systems to ensure that emergency medical service personnel are equipped to appropriately assess patients and immediately transfer them to the closest certified stroke center. Despite these efforts, transfer times often remain beyond the preferred treatment time window.

"The challenge to improve upon stroke systems of care is an opportunity to transform the way we approach stroke treatment, and we're seeing the most progress in the cities, states and regions that are engaging in collective efforts to ensure that patients go to the hospital that is best equipped to treat stroke," said Dr. Donald Frei, president of SNIS. "We have a unique responsibility to continue to invest our time, resources and best thinking to better assist our patients and to continually refine systems of care that will facilitate optimal stroke treatment."

Dr. Froehler pointed out that most changes in systems of care, while well-intentioned, are often not informed by evidence from trials. He has therefore initiated controlled study of stroke care systems at Vanderbilt University Medical Center by comparing different approaches to transporting stroke patients to the right hospital faster. "It's important that we continue to inform best practices and evolve our systems for the good of patients who depend on rapid response and timely intervention. We must rigorously apply the same evidence-based standards that we use for individual patient treatment decisions to the broader systems of care in order to achieve necessary efficiencies that can make a real difference for our patients," said Froehler.

Stroke is the leading cause of disability and the fourth cause of death in the U.S. In 2010, stroke cost the U.S. an estimated $54 billion, including the cost of health care services, medications and missed days of work. Additionally, strokes account for $74 billion in health care expenditures annually for treatment due to disability.
About The Society of NeuroInterventional Surgery

The Society of NeuroInterventional Surgery (SNIS) is a scientific and educational association dedicated to advancing the specialty of neurointerventional surgery through research, standard-setting and education and advocacy in order to provide the highest quality of patient care in diagnosing and treating diseases of the brain, spine, head and neck. http://www.snisonline.org. Follow us on Twitter @SNISinfo.

About the Vanderbilt Stroke Center

The Vanderbilt Stroke Center in Nashville, Tennessee is certified by The Joint Commission as an Advanced Certification Comprehensive Stroke Center. The Vanderbilt Stroke Center offers personalized care to each patient, drawing on an experienced team of experts as well as the latest technology and research findings. The Vanderbilt Cerebrovascular Clinical Research Office is comprised of faculty in neurology and neurosurgery, clinical research coordinators, and research nurses, and is actively serving as the national coordinating center or a participating site in over 20 ongoing clinical trials. Current studies include the Vanderbilt Emergency Stroke Prehospital Assessment Study (VESPA), and the Vanderbilt Acute Stroke Transfer Study (VAST), which apply controlled trial design to systems of care studies.

Society of NeuroInterventional Surgery

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.