Slower nighttime transfers of stroke patients may reduce odds of thrombectomy
Transfer times to an endovascular therapy-capable hospital are an average of 20 minutes slower during nighttime hours at one hub-and-spoke stroke network, possibly leading to a lower likelihood of those patients receiving thrombectomy.
Indeed, out of 234 patients who were transferred from one of 40 “spoke” hospitals to Massachusetts General Hospital, only 27 percent underwent endovascular thrombectomy (ET). Researchers found the odds of thrombectomy were 44 percent for a transfer time of 60 minutes, with odds dropping by 1 percent for each additional minute.
Notably, since this study period ended in October 2015, the American Heart Association/American Stroke Association published updated guidelines extending the window for thrombectomies from six hours to 24.
“In our data nocturnal transfers were associated with a substantial delay relative to daytime transfers, highlighting the recognized impact of care discrepancies during night hours and the potential impact on outcome,” Robert W. Regenhardt, MD, PhD, and colleagues reported in Stroke. “Rapid care delivery for LVO (large vessel occlusion) patients is a healthcare priority given the impact of time on ET outcomes. Because the majority of patients first present to local hospitals and require transfer to ET-capable facilities, it is crucial to evaluate and refine the process of transfer.”
A total of 51 percent of patients were transferred by ambulance while the rest were transported via helicopter. The median transfer time was 132 minutes, a half hour longer than the median ideal transfer time.
Regenhardt et al. noted the expanded use of helicopters for transfers longer than 10 miles, while more expensive upfront, could lead to faster transport and improved outcomes, which would boost their cost-effectiveness. They also believe applying metrics and protocols to night transfers “will likely have a positive impact on transfer times and subsequently patient outcomes.”
The researchers found administration of tissue-type plasminogen activator (tPA) at spoke hospitals occurred in 67 percent of patients and wasn’t associated with transfer delays. They said the somewhat low rate of ET use may be attributed to tPA clearing up occlusions before thrombectomy was necessary.
Regendhardt and colleagues defined nocturnal transfers as all those initiated after 6 p.m. and before 6 a.m. They noted their analysis was limited by its single-center, retrospective design, and acknowledged ET rates may have increased nationally since their study period ended in October 2015.
Mary joined TriMed Media in 2003. She was the founding editor and editorial director of Health Imaging, Cardiovascular Business, Molecular Imaging Insight and CMIO, now known as Clinical Innovation + Technology. Prior to TriMed, Mary was the editorial director of HealthTech Publishing Company, where she had worked since 1991. While there, she oversaw four magazines and related online media, and piloted the launch of two magazines and websites. Mary holds a master’s in journalism from Syracuse University. She lives in East Greenwich, R.I., and when not working, she is usually running around after her family, taking photos or cooking.