A systemized strategy to reduce door‐to‐puncture time using the ELVO screen: “Code AIS

Author:

Inoue Hiroyasu1ORCID,Nishikawa Yusuke2,Oomura Masahiro1ORCID,Hattori Tomonori3,Hayashi Yuki2,Yamanaka Tomoyasu2,Uchida Mitsuru2,Taniguchi Yoko1,Suzuki Kengo1,Madokoro Yuta1ORCID,Sato Toyohiro1,Fujioka Teppei1,Mizuno Masayuki1,Kawashima Shoji1,Okita Kenji1,Mase Mitsuhito2,Matsukawa Noriyuki1

Affiliation:

1. Department of Neurology Nagoya City University Graduate School of Medical Sciences Nagoya Japan

2. Department of Neurosurgery Nagoya City University Graduate School of Medical Sciences Nagoya Japan

3. Department of Emergency Medicine Nagoya City University Hospital Nagoya Japan

Abstract

AbstractBackgroundA shorter onset‐to recanalization (O2R) time in mechanical thrombectomy for acute ischemic stroke (AIS) results in better outcomes. Thus, we should reduce the door‐to‐puncture (D2P) time.AimTo evaluate the effectiveness of a triage system named “Code AIS.” We adopted the emergency large vessel occlusion (ELVO) screen as a screening test.MethodsUsing the ELVO screening test, Code AIS was invoked when ≥1 positive results were obtained without witnessed seizures. The Code AIS system requires the assembly of neurologists, neurosurgeons, and an endovascular team in the emergency department before a patient arrives at the hospital. In total, 104 consecutive patients who underwent thrombectomy after emergency transport from January 2015 to December 2022 were included. The Code AIS system was initiated on February 17, 2022, and patients were divided into the pre‐Code AIS and Code AIS era groups. D2P time, outcome, and other parameters were compared between the groups.ResultsEighty‐eight and 16 cases were in the pre‐Code AIS and Code AIS era groups, respectively. Background factors, including age, sex, and etiology, did not differ between the groups. The median (interquartile range) time of D2P in the Code AIS era was 60 (41–102) min and significantly shortened compared to 135 (109–161) min in the pre‐Code AIS era (p < 0.001). The proportion of patients with favorable outcomes (modified Rankin Scale score, 0–2) improved significantly from 33% (pre‐Code AIS era) to 63% (Code AIS era) (p = 0.047).ConclusionUsing Code AIS, we succeeded in shortening D2P time and improving patient outcomes.

Publisher

Wiley

Subject

Neurology (clinical),Neurology

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