"Picture to Puncture": a Novel Time Metric to Enhance Outcomes in Patients Transferred for Endovascular Reperfusion in Acute Ischemic Stroke
Background—Comprehensive stroke centers allow for regionalization of subspecialty stroke care. Efficacy of endovascular treatments, however, may be limited by delays in patient transfer. Our goal was to identify where these delays occurred and to assess the impact of such delays on patient outcome.
Methods and Results—This was a retrospective study evaluating patients treated with endovascular therapy from November 2010-July 2012 at our institution. We compared patients transferred from outside hospitals to locally treated patients with respect to demographics, imaging, and treatment times. Good outcomes, as defined by 90 day modified Rankin Scores of 0-2, were analyzed by transfer status as well as time from initial CT to groin puncture (Picture-to-Puncture, P2P). A total of 193 patients were analyzed with a mean age of 65.8±14.5 years and median NIH Stroke Scale of 19(IQR15-23). More than two-thirds of the patients, 132(68%), were treated from referring facilities. Outside transfers were noted to have longer 'P2P' times (205 mins [IQR162-274] vs. 89 mins [IQR70-119]; P<0.001) attributable to the delays in transfer. This corresponded to fewer patients with favorable Alberta Stroke Program Early CT Scores (ASPECTS) on pre-procedural CT imaging (ASPECTS>7: 50% vs. 76%; P<0.001) and significantly worse clinical outcomes (29% vs. 51%; P=0.003). In a logistic regression model, "P2P" times were independently associated with good outcomes (OR 0.994; 95%CI 0.990-0.999; P=0.009).
Conclusions—Delays in "P2P" times for inter-hospital transfers reduce the probability of good outcomes among treated patients. Strategies to reduce such delays herald an opportunity for hospitals to improve patient outcomes.
- Received December 21, 2012.
- Revision received January 25, 2013.
- Accepted January 29, 2013.
- Copyright © 2013, Circulation