Interhospital Transfer Analysis For The Endovascular Treatment Of The Acute Stroke. Summa 112

V Real Martinez (SUMMA 112), E Pastor Benito (SUMMA 112), C Cardenete Reyes (SUMMA 112), N Riera López (SUMMA 112), A Barberá Gómez (SUMMA 112), J Rodríguez Pardo de Donlebún (Universitary Hospital La Paz. Madrid)

Key words: stroke-endovascular procedures-medical services urgency-Madrid Direct

Background:

In Spain, cerebrovascular diseases are the second cause of
of global mortality and the first one in women. The endovascular treatment (ET, mechanical thrombectomy) has demonstrated been a benefit for stroke patients. The rise of this treatment has induced overload of prehospital emergency services due to increase of Emergency Interhospital Transfers (EIT) to comprehensive stroke centers with the consequent delay and increase of futile interhospital transfers. To try to alleviate the problem, on March 1, 2017 it was implemented in SUMMA112 (Service of Medical Emergencies of the Community of Madrid) a new scale (#Madrid-Direct) in the Stroke Code procedure (SC) to select the destination hospital for patients with suspected large vessel occlussion in order to reduce EIT.

There is a lack of research about the epidemiological description of patients who require this type of transfers (stroke EIT) and of the used times, data to take into account for this time-dependent emergency.

Targets

Evaluate the effect of the MADRID-DIRECT prehospital stroke scale for 10 months since its implementation compared to the same months of the previous year.

Amount of EITs
Door-in / Door-out time.
Relationship between time and distance between hospitals sending and receiving (Node).

Material and methods:

An analytical, observational, transversal and retrospective study was carried out of all urgent EITs for endovascular treatment in SUMMA112 between March and December 2016 and 2017.

Variables: age, sex, type of resource, activation time,
Door-in / Door-out time, hospital ...

Descriptive and inferential analysis was performed with the SPSS® software version 23.0.
The qualitative variables were expressed by frequency and percentage. The quantitative variables such as mean and standard deviation a 95%, a confidence interval was established, considering significant values those whose value of p <0.05.

Results:

Study population: 327 EITs.

Since the implantation of the MADRID-DIRECT scale, there has been a decrease in EIT (2017: 105 vs 2016: 168) as well as the proportion of EIT for each 100 attended Stroke Code (2017: 9.37 EIT per 100 CI vs 2016: 21.11 EIT for every 100 CI).
The mean age (± SD) was 69.45 ± 15 years. Women represent 49.50% of the sample with an age higher than that of the mens.
85.02% of the EITs were carried out in Advanced Life Support units (ALSu) and the node hospital that received the most EIT was the one of the north node (19.57%).
The average time from the acceptance of the EITs until the arrival of the mobile resource to the requesting hospital was 24.50 ± 24.95 min. being found differences in relation to the hospital (p = 0.001) and the unit that the EIT (ALSu vs ambulance p = 0.006).
Door-in / Door-out time was 38.28 ± 16.17 min. and although it observed a slight increase in time in 2017 was not established a statistical association (p = 0.125).
The average distance traveled by the responsible mobile resources of the EITs was 13.32 ± 7.88 km. Very similar distance in the two years studied (p = 0.959).

Discussion

This study shows that the implementation of the MADRID-DIRECT prehospital stroke scale has significantly increased the number of primary activations (number of SC) and has reduced the number of urgent EITs, increasing access to stroke treatment in acute phase and reducing the time to it.

The characteristics of the population are similar to the rest of the studies in relation to the percentage and age of women.
Although we have found a statistical association between time of mobilization / arrival with the hospital and the resource, we think that other variables such as the GPS positioning of the mobile resource would have thrown more accurate data.
It has not been possible to demonstrate that the implementation of the new protocol Door-in / Door-out times have decreased.

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