Abstract
Abstract WP5: The Transfer Score May Aid Decisions Whether to Transfer Patients with Large Vessel Occlusions for Endovascular Therapy
Stroke (1970), v 48(suppl_1)
Feb 2017
Abstract
Abstract only
Background:
While faster reperfusion with EVT leads to better outcomes in acute ischemic stroke due to large vessel occlusion (LVO), most LVO patients present to outside hospitals without EVT capability. Treating physicians are often unsure if EVT would confer benefit upon arrival to tertiary hospitals given inter-facility transfer delays.
Objective:
We evaluated independent predictors of good outcome in transferred patients treated with EVT to devise a score that may assist treating physicians to make transfer and treatment decisions.
Methods:
Transfer patients were analyzed in a multicenter international prospective cohort study of LVO patients treated with stent retriever thrombectomy (TREVO Registry) from 11/2013 to 4/2016. Independent factors correlating with good outcome after EVT were identified using univariate and multivariate analyses. We devised a score to identify patients with LVO at the referral facility who may benefit from EVT.
Results:
Of 1000 patients enrolled, 226 were anterior circulation occlusions, transferred and treated within 0-8 hrs (Table 1). Age, stroke severity, glucose level, M2 occlusion and achieving onset to groin puncture ≤ 5 hr were independent factors associated with good outcome (Table 2). Other clinical variables were analyzed, as in ASPECTS, but were not significant. A 10 point score was devised (Table 3). Patients with a score of 0-4 had 4 times the odds of good outcome compared to a score of 5-9 (aOR 4.3, 95% CI 1.9-9.9;
p
<0.001). These results were maintained after adjustment for mTICI and IV-tPA (aOR 4.0, 95% CI 1.7-9.4;
p
<0.001). Fig 1 shows good outcome rates stratified by score points. ROC curves showed better score performance (AUC= 0.8) compared to THRIVE (AUC=0.74) and HIAT (AUC=0.69) certifying good predictability.
Conclusion:
A simple transfer score may be an effective triage method to identify patients at remote facilities who may benefit from EVT upon transfer. Further validation is necessary to confirm these findings.
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Details
- Title
- Abstract WP5: The Transfer Score May Aid Decisions Whether to Transfer Patients with Large Vessel Occlusions for Endovascular Therapy
- Creators
- Amrou Sarraj - Texas NeurologyErol Veznedaroglu - Neurosciences InstituteRonald F Budzik - Riverside Methodist HospitalJoey D English - California Pacific Medical CenterBlaise W Baxter - Erlanger Health SystemBruno M Bartolini - Fondation de RothschildDavid S Liebeskind - UC Los Angeles, Dept of Neurology, Los Angeles, CAAntonin Krajina - University of Hradec KrálovéRyan D Shields - StrykerBin Xiang - Analytical ServicesRaul G Nogueira - Emory UniversityRishi Gupta - WellStar Kennestone HospitalMark Dannenbaum - Texas NeurologyChristine M Farrell - Texas NeurologyLouise D McCullough - Texas NeurologySean I Savitz - Texas Neurology
- Publication Details
- Stroke (1970), v 48(suppl_1)
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Neurosurgery
- Other Identifier
- 991021962289604721