SNIS 2022: Direct triage to Level 1 stroke centres reduces time to treatment and improves patient outcomes

Mahesh Jayaraman presenting at SNIS 2022

Implementing severity-based field triage leads to faster treatment and less disability for stroke patients, according to late-breaking research presented recently at the Society of NeuroInterventional Surgery’s (SNIS) 19th annual meeting (25–29 July, Toronto, Canada).

These findings, which are now also published online in the Journal of NeuroInterventional Surgery, show that US states using field-based stroke severity triage as part of their Emergency Medical Systems (EMS) transport protocols give severe stroke patients more rapid access to specially trained neuroendovascular care teams and lifesaving thrombectomy procedures. In the study, “Long-term effect of field triage on times to endovascular treatment for emergent large vessel occlusion”, researchers compared stroke patients between two adjacent states over a 5.5-year span. Both states were served by a single Level 1 (comprehensive) stroke centre.

After matching the patients from the two regions based on distance to the Level 1 centre, the researchers found that time to treatment decreased by 55 minutes following 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 jeopardises a patient’s chance of recovery,” said Mahesh Jayaraman (Brown University/Rhode Island Hospital, Providence, USA), lead author of the study, who also presented these findings at SNIS 2022. “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.”

Like trauma, stroke is time-sensitive—and 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 centre), 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. The researchers believe this new study confirms the previous results and shows just how critical changing EMS protocols are to a patient’s survival.


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