Impact of prehospital comprehensive stroke center vs. primary stroke center triage protocol on outcome of patients with spontaneous intracerebral hemorrhage

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI:10.1016/j.jstrokecerebrovasdis.2026.108555

Tracey H Fan , Molly Lawrence , Elena Badillo Goicoechea , Angela Wick , Shyam Prabhakaran

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引用次数: 0

Abstract

Purpose

While prehospital triage protocols for suspected large vessel occlusion (LVO) improve ischemic stroke outcomes, their impact in spontaneous intracerebral hemorrhage (sICH) remain uncertain. We evaluated whether a regional LVO-focused emergency medical service (EMS) transport protocol affected time-based process outcomes and clinical outcomes in sICH patients.

Method

We conducted a multicenter pre-post implementation retrospective cohort study using the Get-With-The-Guidelines-Stroke database in Chicago (April 2017–January 2020). Included were EMS-transported sICH patients arriving ≤6 hours from last known normal at 8 comprehensive stroke centers (CSCs) and 15 primary stroke centers (PSCs). In September 2018, EMS implemented the 3-Item Stroke Scale (3I-SS) to triage suspected LVO stroke patients; those scoring ≥4 were routed to a CSC bypassing PSC. Primary outcome was favorable discharge disposition (home/acute rehabilitation). Secondary outcomes included in-hospital mortality, good neurologic outcome (independent ambulation) at discharge and time based process outcomes (door-to-CT, symptom-to-arrival, symptom-to-CT). Interrupted time series (ITS) analysis assessed changes while accounting for temporal trends.

Findings

Among 303 sICH patients (111 pre-, 192 post-implementation), there was no difference in favorable discharge disposition (58% vs. 64%, p=0.3), in-hospital mortality (12% vs. 9%, p=0.4) or good neurologic outcomes (13% vs. 19%, p=0.4) between pre-post implementation periods for both unadjusted or ITS analyses. Time based process outcomes showed no significant changes in unadjusted or ITS analyses. The protocol also did not impact CSC admission and inter-hospital transfer rates in ITS analyses.

Discussion/Conclusion

Implementation of an LVO-focused EMS transport protocol did not improve clinical outcomes or time-based process outcomes among sICH patients, nor did it influence CSC admission or transfer rates. These findings suggest that while beneficial for ischemic stroke care, LVO triage protocols may not confer the same advantages for sICH patients and may require tailored approaches for this population.

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院前综合卒中中心与初级卒中中心分诊方案对自发性脑出血患者预后的影响

目的：虽然院前分诊方案可改善疑似大血管闭塞（LVO）的缺血性卒中预后，但其对自发性脑出血（sICH）的影响仍不确定。我们评估了区域性以lvo为重点的紧急医疗服务（EMS）转运协议是否会影响siich患者基于时间的过程结果和临床结果。方法：我们在芝加哥（2017年4月- 2020年1月）使用Get-With-The-Guidelines-Stroke数据库进行了一项多中心实施前后回顾性队列研究。研究对象包括8个综合卒中中心（CSCs）和15个初级卒中中心（PSCs）在离最后一个已知正常人≤6小时到达的ems转运的siich患者。2018年9月，EMS实施3项脑卒中量表（3I-SS）对疑似LVO脑卒中患者进行分诊；评分≥4分者绕过PSC进入CSC。主要结局是良好的出院处置（家庭/急性康复）。次要结局包括住院死亡率、出院时良好的神经系统结局（独立行走）和基于时间的过程结局（从门口到ct、从症状到到达、从症状到ct）。中断时间序列（ITS）分析评估了变化，同时考虑了时间趋势。结果：在303例sICH患者中（实施前111例，实施后192例），在未调整或ITS分析中，实施前后期间良好的出院处置（58%对64%，p=0.3）、住院死亡率（12%对9%，p=0.4）或良好的神经系统预后（13%对19%，p=0.4）均无差异。基于时间的过程结果显示未调整或ITS分析没有显著变化。在ITS分析中，该方案也没有影响CSC住院率和医院间转院率。讨论/结论：实施以lvo为中心的EMS转运方案并没有改善sICH患者的临床结果或基于时间的过程结果，也没有影响CSC的入院或转运率。这些发现表明，虽然有利于缺血性卒中的治疗，但LVO分诊方案可能不会给siich患者带来同样的优势，可能需要针对这一人群量身定制的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.