Patients with a suspected acute ischemic stroke who are taken by emergency medical services (EMS) directly to comprehensive stroke centers rather than the nearest stroke center for care are more likely to receive endovascular therapy, according to research led by investigators at the University of Chicago Medicine, in collaboration with local healthcare and emergency response groups.
The study underscores the importance of a regional policy that has guided EMS response in Chicago to a suspected stroke since 2018 — which the researchers say will lead to improved outcomes for patients. The results were published on August 9 in JAMA Neurology.
“Regional policies for stroke care are still in their nascence compared to cardiac or trauma care, where there is more experience in directing people to the right hospital based on their needed level of care,” said Shyam Prabhakaran, MD, Professor and Chair of Neurology at UChicago Medicine, and the study’s senior author. “We are one of the first regions in the United States to implement this kind of tiered policy for stroke.”
Several years ago, the American Heart Association issued a recommendation that patients suspected by EMS to have a large vessel occlusion be transported to the nearest comprehensive stroke center, as long as it was within a reasonable distance. Evidence has shown that comprehensive stroke centers provide critical treatments that improve outcomes for patients with large vessel occlusions, or blocked arteries, which account for most of the disabling strokes.
Following this recommendation, hospitals and emergency services in the city of Chicago worked together to develop a new regional policy to guide the EMS response to a suspected stroke.
The UChicago Medicine-led team of researchers decided to use implementation of the policy in 2018 to better understand how the policy change affected stroke care. The team included a variety of collaborators from the University of Chicago, Northwestern University, the Chicago EMS system, Advocate Illinois Masonic Medical Center, the Cook County Health Department of Emergency Medicine, and the American Heart Association.
“It is really tragic when an ischemic stroke patient gets delayed care. Time is brain: the minutes and hours that are lost when a patient has to be transferred from one hospital to another can’t be regained, which often leads to worse outcomes,” said Prabhakaran. “Systems of care like ours in Chicago have developed protocols to identify stroke patients based on stroke severity in the field and move them to the right hospital. Now, we’re one of the first to have implemented such a system and studied its effect.”
