Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas
Author:
Garcia-Tornel Alvaro1ORCID, Millan Monica2ORCID, Rubiera Marta1ORCID, Bustamante Alejandro2ORCID, Requena Manuel1ORCID, Dorado Laura2ORCID, Olivé-Gadea Marta1, Jiménez Xavier3ORCID, Soto Angels3ORCID, Querol Marisol3, Hernández-Pérez MariaORCID, Gomis Meritxell2ORCID, Cardona Pere4ORCID, Urra Xabier5, Purroy Francesc6ORCID, Silva Yolanda7ORCID, Ustrell Xavier8ORCID, Esteve Patricia9, Salvat-Plana Mercè10ORCID, Gallofré Miquel11ORCID, Molina Carlos1, Dávalos Antoni2ORCID, Jovin Tudor12ORCID, Abilleira Sonia13ORCID, Ribo Marc1ORCID, Pérez de la Ossa Natalia210ORCID, Jacobi Marc Ribó, Sanjuan Estela, Santana Katherine, Rodríguez Noelia, Pagola Jorge, Rodriguez-Luna David, Maisterra Olga, Santamarina Estevo, Muchada Marian, Juega Jesús, Boned Sandra, Franco Antonio Palasi, García -Tornel Álvaro, Deck Matías, Sala Victoria, Muñoz Lucía, Millán Mónica, López-Cancio Elena, Hernández-Pérez María, Ciurans Jordi, Samaniego Daniela, Canento Tamara, Martin Lorena, Planas Anna, Broto Joaquin, Sorrentino Agustín, Paré Martí, Zhu Nuole, Garrido Alicia, Grau Laia, Crespo Ane Miren, Presas Silvia, Almendrote Miriam, Ramos Alba, Lucente Giuseppe, Ispierto Lourdes, Lozano Manuel, Becerra Juan Luis, Jiménez Marta, Rolán Dolores Vilas, Guanyabens Nicolas, Sanchez-Ojanguren Josep, Martínez-Piñeiro Alicia, Forcén Sara, Gea Mireia, Álvarez Marta, Ramos Anna, Lizarbe Manuel Domínguez, Guerra Sara, Rubio, Bragado Irene, Arbex Andrea, Rodríguez Luis, Portela Pere Cardona, García Helena Quesada, Rodríguez Blanca Lara, Cayuela Nuria, Miró Julia, Marzal Clara, Paipa Andrés, Campoy Sergio, Núñez Ana, Arroyo Pablo, Besora Sarah, Adell Vanessa, Campdelacreu Jaume, Martí Montse Alemany, González Belén, Vila Laura Bau, Crespo Marta Fiter, Berbel Anna, Urbaneja Ma. Cristina Villaescusa, Guillen Núria, Vidal Nuria, Vérez Santamaria Patricia Valentina, Navarro Diego Herrero, Simó Marta, Falip Mercedes, Matas Elisabeth, Ochoa Neus Mongay, Gifreu Ariadna, Muñoz Albert, Romero Lucía, Portell Eduard, Perez Guillermo Hernández, Esteve F. Ruiz, Teixidor Silvia, Talavera Augusto Salazar, Gómez Roser, Nuin Xabier Urra, Vargas Martha, Chamorro Ángel, Amaro Sergio, Llull Laura, Renú Arturo, Rudilosso Salvatore, del Valle Raquel Sánchez, Ariño Helena, Solà Nuria, la Puma Delón, Gil Francisco, Gómez Juan Bernardo, Matos Nuria, Falgàs Neus, Borrego Sergi, Sánchez Almudena, Balasa Mircea, Montejo Carmen, Guasp Mar, Reyes David, Cervilla Pablo Sánchez, Contador Jose Miguel, Vera Monge Victor Augusto, Ramos Oscar, Rodríguez Alejandro, Campello Ana Rodríguez, Ballester Gemma Romeral, Trujillano Mireia Llop, Steinhauer Eva Giralt, Godia Elisa Cuadrado, Ois Santiago Angel Javier, Conde Jordi Jimenez, Fábregas Joan Martí, Guisado Daniel, Prats Luís, Camps Pol, Delgado Raquel, Domeño Alejandro Martínez, Marín Rebeca, Cànovas David, Estela Jordi, Ros Marta, Aranceta Sonsoles, Espinosa Jordi, Rubio Marta, Lafuente Cristina, Barrachina Oriol, Anguita Alicia, Reverter Anna, García Carmen, Sansa Gemma, Hervas Mariona, Crosas Monica, Delgado Tania, Krupinski Jerzy, Folch Sonia Huertas, Gamito Gemma Muñoz, Alvarez Josep Trenado, Subirana Teresa, Molina Jessica, Besora Sarah, Romero Laura Comes, Valls Gemma Guardia, Jover Miriam, Sotova Javier Joaquín, García Sánchez Sonia Mª, Valenzuela (intensivista) Sebastian, Gómez-Choco Manuel, Mengual Juan José, Font M. Àngels, Gómez Ruiz Mª Isabel, Zubizarreta Irati, González Susana Fernández, Gubieras Laura, Cobos Carmen E., Romo Luis Mena, Caballol Nuria, Cano Luis, Leal Joaquín Serena, Izarra Mikel Terceño, Trigo Irene Bragado, Viturro Saima Bashir, Albiñana Laura Pardo, Garrido Montserrat Reina, Cazcarra Carla Marco, Uscamaita Karol Enrique, Márquez Fabian, Coll Cristina, Lloret Villlas Mar Irida, Vila Berta Solano, Alemany Perna Berta, Domínguezl Daniel López, de Lera Mercedes, Cots Foraster Anna, Vera Monge Victor Augusto, Bojaryn Urszula, Benabdelhak Ikram, Capdevila Gerard Mauri, Sanahuja Montesinos Jordi, Vázquez Daniel, Vicente Hervás José, González Cristina, Quílez Alejandro, Pascual Mikel Vicente, Ruiz María, Riba Yolanda, Gil Villar M. Pilar, García Cristina, Roig Xavier Ustrell, Mora Mònica Baldrich, Guinjoan Anna Pellisé, Borras Judit, Mañé Martínez Alba, Marés Rafael, Viñas i Gaya Jaume, Seró Laia, Flores Alan, Rodríguez Paula, Castilho Gislaine, Ortega Angela Monterde, Reverté Silvia, Zaragoza Josep, Baiges Joan Josep, Zaragoza Josep, Ozaeta Gisela Martín, Escalante Sonia, Payo Iago, Salvado Júlia Saura, Sala Natalia Mas, Soler Insa Josep M, Vilamala Ester Tio, Navarro Josep Abos, Tabuenca Héctor Cruz, Canento Sánchez Tamara, Ros Marta, Matos Nuria, Roldán Elisabet, Rubiol Elsa Puiggrós, Franquet Elisabet, Fuentes Lidia, Donaire Javier, Martí Elena, Giménez Laura, Vázquez Junior Gil, Clara Gris Ambrós Eloisa Nieto, Rodríguez Puri, Oletta José Félix, Mellado Pilar Pons, Gómez Catena, Bárbara, Raileau Vergilin, Ruíz Esther Catena, Pardina Oscar, Mercadal Jordi, López-Diéguez María, Pérez Pilar, Gabarró Lourdes, Orriols María, Canet Joan Josep, Roca Mireia, Álvaro Muriel, Boneu Francesc, Giménez Georgina, Albà Jaume, Gibert Francesc, Garcia Jéssica, Barragan Patricia, Jurado Gustavo, Ortega Josep Sabaté, Martínez Solano Joan Amaurys, Fernández Víctor, Torres Mónica, Belén Montero Alvaredo Ana, Redondo Parejo Laura, Maria Aragonés Josep, Bullón Anna, Loste Cora, González Paula, Bejarano Neker, Sanchez Francisco, Lucchetti Gianni, Pla Xavier, Gimeno Javier, Reynaga Esteban, Barcons Montse, Celedón Gabriel, Ortiz Juan, Anastasovski Goran, Mascaró Oscar, de los Ríos Javier Diez, Feliu Meritxell, Ribera Anna, Ruiz Cristhian, Corominas Gerard, Nunes Daniella, Roca Claudia, Latorre Nadina, Yataco Lizbeth, Cruz Maricelys, Blanco Nerea, Castejón Santiago, Calderón Dolores Cocho, Sunyer Claustre Pont, Garcia Jordi Espinosa, Martin Rodrigo Paz, de Luis Sanchez Albert, Vivas Dolores Espinosa, Molina, Gemma Juan Valencia, Palome Planels, Chaume Laia Tomas, Vilella Ares Villagrasa, Bustamante Marco, Boltes Anunciación, Rodríguez Fernando, Arrieta Itziar, Ciurans Molist Jordi, Andreu Barnés, Soler Ernest Palomeras, Buscà Nicolau Guanyabens, López Manuel Daza, Farreres Jordi Bigas, Ruiz Virginia Casado, Batiste Desiree Muriana, Sanz Cartagena Mª Pilar, de Vega Eulalia Cabot, Real Josep Bassa, Roman Hector Pelaez, Socolich César, Alonso Camp Josep Mª, Cano Orgaz Antonio Tomás, Fossas Felip Mª Pilar, Morón Nicolás, Bacca Sandra, Molina Mauricio, Casarramona Francesc, Elias Lorena, Bukaei Muhammad Zidane, Martos Gutierrez Jose Antonio, Escuin Judith Lopez, Olaizola Cristina, Vargas Yolexis López, Jiménez Oyonarte Juan, Soultana Rashida, Golpe Eduardo Sanjurjo, Salvador Esther, Vila Guillem, Serrano Marcos, López Claverol Matilde Nuria, Lamolla Marian, Amate Miquel, Rodriguez Adriana, Romero Ruth, del Carpio Montgomery, Hernandez Ana Isabel, Martín Julián, Rosas M Carmen, Nogueroles Antonio, Encarnación Sorilandy, Robles Augusto, Herrera Jose Antonio, Gavilán Roger, Mameghani Toghrol, Araujo Gastón, Garrido Morales M.Angeles, Albert Segui Enric Ramon, Climent Eva Fernandez, Pujol Francesc Paris, Garrofé Seira Mireia Judit, Pía Lucía Gómez, Nuñez Fernando Salleres, Peñalver Cristina Aguar, Lopes Cristina Vaz, Ribera Tasa Elisenda, Vilchez Carmen Repullo, Zambrana Modesto Sánchez, Ribas Beatriu Suescun, Panés Inés Vilà, Planavila Montserrat Vila, Lorenzo Alicia Vaqueiro, Guixes Meritxell Sabartés, Medina Jorge, Sambrano David, Zamarreño Javi, Pirela Carmen, Vélez Paola, Cajamarca Luis, Pérez Honey, Martínez Yarles, Alexander Gonçalves Jesus, Regordosa Carles, Mormeneo Claudia, Griu Laura, Francia Colina Maria, Farik Enric, Duch Dolors Carrión, Badenas Carles, Bernal Oscar, Agramunt Núria, Morales Shyrlei, Reynoso Victoria, Guerrero Miguel, Romera Cid Primitivo, Folqué Mònica, Pedroza Claudia, Hachem Adnan, Martínez Íñigo Soteras, Verdera García Xavier, Amorós Mercè López, Subirós Xavier Costa, Benet Marta Cufí, Van Eendenburg Cecile, Osuna Teresa, Santos Dra Gina, Pallisera Mireia, Oliva Lluís Gonzalo, Sanchez Gemma, Basurto Xavier, Vivoda Ludgi, Van der Kleyn Richard, Robles Laura, Cabanelas Barranco Ana, Almendros Mª Cruz, Oliveras Marc Pérez, Álvarez Amelia Fernández, Rybyeva Maria, Viñas Antoni, Barcons Maria, Alberto Tavera Joaquim Danès, Burbano Pablo, López Cintie, Cruz David, Bisbe Paula, Fernández Nora, Carlos Palacio Juan, Fraiz Eduardo, Aguiló Oriol, Amorodjo Rollmy, Velázquez John, Sánchez Elena, Español Jaume, de Celis Judit Perez, Coll Anna, Díaz Glòria, Vergés i Sala Margarida, Casas Capdevila Mª Ángels, Ferrini Yosmairy Yoselin, Gorriz Aitor, Cucurell Navarro Diego-Javier, Velásquez Dulce, Pla Soler Jaume, González Josep, Higuera Julian David, Cuellar Lina, Miniello Liza Margarita, Pujol Lluis, Cracan Sorin, Vives Mora, Angela M, Lopez Lopez, Anabel , Molist Montse Gorchs, Anna Delofeu, Muñoz Silvia Solà, Yolanda Ferreres, Pujalte Carol, Téllez Marín Elisabeth, Font Casas Yolanda, Hernández Luque Sara, Sendra Joaquim Mejias, Valero Francesca Mellado, Escala Campos, Lacanal Galup De, Diaz Lopez, Paramio Castillo, Estopà Català, Moreda Español, Majo Calafell, Almeida Carballo, Naval Castro, Elena M, Ruiz Cregut, Lluis Pere, Font Deulofeu, Sanjuan Fabregat, Pere Joan, Gorchs Fontquerni, Bellés Forés, Antoni Joan, Herrera Gomez, Carlos Juan, Prades Hijazo, Torvisco Itzaina, Rovira Marti, Gonzalez Obiols, Cavero Olive, Gil Querol, Soledad M, Rodriguez Rico, Sambernardo Rios, Molina Ropero, Ramon Jose, Valero Sanchez, Arevalo Santos, Jose Maria, Garcia Soto, Angeles Maria, Escribano Tebar, Garcia Torres, José Pedro, Carrion Verdes, Isabel M, Lopez Verge, Jose Juan, Canela Lopez, Angeles M, Guarque Lucas, Alvarez Morales, Arnulfo Jorge, Fornieles Morell, Gomez Subirats, Teresa Maria, Masa Torello, Lopez Val, Mercedes Maria, Reyes Palmero, Manuel Juan, Forne Rodriguez, Turiel Ruana, Gonzalez Sanchez, Gornals Sebastia, Rico Abrio, Falip Albert Gual, Oliveros Aznar, Perotti Brugues, Molinero Calvet, Franco Catells, Medina Corrales, Miro Daroca, Marquez Duran, Pradas Feliu, Casanova Figueras, Tortajada Garcia, Gallego Grajera, del Mar Azahara, Arroyo Las, de Jesus Dulcenombre, Sanz Laserreta, Vidal Llambrich, Corral Monllao, de la Cruz Morales, Blanco Moreno, Orgaz Orejuela, Suazo Piñana, Minguillon Pons, Gómez Rodríguez, Carlos José, Pereira Rodriguez, Porcel Sedo, Villar Sevil, Lopez Sierra, Romero Torres, Calveres Trepat, Arnella Ventura, Gil Acera, Teresa M, Vico Biesot, Galea Castro, Maria Rosa, Chafer Escorcia, Antonio Juan, Moreda Español, Faure Gil, Luque Hernandez, Delgado Jimenez, Gay Mallafre, Angel M., Sanzo Olivares, Fondevila Pubill, Fort Sabate, Agámez Segovia, Carlos Antonio, Longaretti Turata, Hernandez Valle, Guixens Trayner, Valor Aguilar, Alvarez Aguirre, Naval Alastrue, Baquero Alferez, Marne, Cristina Alonso, Orozco Aloy, Colino Alvarez, Peñuela Alvarez, Cirilo Ameller, Vanessa Maria, Guerrero Andujar, Remedios Estefania, Sillero Auladell, Sorbet Azcarate, Genesca Basany, Barduena Benavent, Tudela Benito, Pardo Blanch, Pla Boluda, Gonzalez Bonilla, Serramalera Bru, Andreu Burnat, Calvo-Rayo Caballero, Casellas Calvo, Mombiela Camps, Bresme Cano, Fernandez Carcelen, Solà Caro, Matavacas Casasas, Bolado Castanedo, Cortina Cerdeña, Jane Abella, Collado Borrego Laia, Orri Colom, Vilanova Comellas, Sole Conillera, Torres Cots, Estepa Cuchi, Graell de Sostoa, Lopez del Rio, Compte Delgado, Bueno Diaz, Maneiro Diaz, Lucia Andrea, Palau Domenech, Carme M., Carasso Duran, Javier Pablo, Marquez Duran, Abidi El, Martin Escoda, Casanovas Esteve, Perez Fernandez, Quintero Ferre, Escobar Flores, Abad Fontcuberta, del Valle Fortes, Luisa Mª, Quesada Franco, Maria Sara, Romero Franco, Teresa Maria, Francisco Gallego, Gala, Alicia Gamiz, Castañeda Garcia, Rodriguez Garcia, Gemma Casajuana, Arroyo Gomez, Girbau Gomez, Fernandez Gonzalez, Gonzalez Gonzalez, Gonzalez Gonzalez, Lopez Gonzalez, Obeso Gual, Blanco Guerrero, Roca Guillemas, Eudaldo Guillermo, Sebastia Hernandez, Covas Homar, Alvarez Hostench, Royo Huerta, Barcelo Ibañez, Cruz Izquiero, Urdangarin Etxetxikia Jaione, Gimenez Juárez, Alami Khlifi, Gasco Laparra, Moreales Lara, Arroyo Las, de Jesus Dulcenombre, Medina Lasaosa, Lourdes Maria, Cava Lazaro, Berrar Leon, Maturana López, Ramirez Lopez, Romero López, Marco Lorente, Martin Lorenzo, Casals Lozano, Nicola Lujan, Diaz Madrid, Antonio Jose, Peris Morales Maria Teresa, Clemente Marti, Castaño Martinez, Natanael David, Gamez Martinez, Gonzalez Martinez, Quesada Martinez, de la Cabeza Maria, Fusté, Mireia Marzà, Conillera M, Lasheras Melendo, Mestre Miralles, Puig Pastalle Montserrat, Vidal Montserrate, Mellado Mora, Ponce Morales, Fornieles Morell, Cabre Morera, Vivet Morera, Souza Mundi, Quiles Muñoz, Rosa Navea, Iglesias Neira, Asuncion M, Manrique Nuñez, Pilar Mª, Martinez Obiols, Reig Pallares, Torres Partegas, Berengueras Pascual, Gamez Perez, Oset Perez, Restrepo Perez, Alejandra Maria, Yeste Planas, Mangado Planells, Minguillon Pons, Carbonell Puertas, Blanco Quinteiro, Benavente Rebollar, Fernandez Recasens, Gomez Reyes, del Carmen Maria, Pou Roca, Ferrer Rodriguez, Franco Rodriguez, Fuertes Rodriguez, Muñoz Rodriguez, Navarro Rodriguez, Iniesta Roig, Gracia Romero, Brunet Rovira, de Eugenio Rovira, Baena Rubio, Llorens Ruiz, Llamazares Sala, Alaez San Juan, Segura Sanchez, Soldevilla Santasusana, Salmeron Sanz, Perez Segura, Balcells Serra, Dumitras Sorina, Montoya Teixidor, Vicente Tena, Salinas Tierno, Ines Ester, Testa Toledo, Figueras Tomàs, Ruperez Tomas, Garcia-Penche Torrano, Esparza Torres, Uku Florenc, Blanco Vazquez, De la Paz Vazquez, Gil Vazquez, Gonzalez Vazquez, Meler Vidal, Cots Vilalta, Jimenez Vilches, Jose Maria, Fernandez Visser, Gavin Viu, Vives Vives, Jimenez Carmona, Jose Francisco, Vilches Galobardes, Gomez Gonzalez, Manzanera Jodar, Cortes Marimon, Orive Marrodan, Bosch Martin, Jose Maria, Lopez Martorell, Roca Millares, Jesus M, Guri Miralles, Hernandez Muliterno, Oliva Muñoz, Pujol Pons, Conde Postius, Arruñada Prieto, Antonio Jose, Mathé Quintana, Mata Rosell, Alvarez Aguirre, Alvarez Alvarin, Flores Arrufat, Pago Bañuelos, Andreu Burnat, Vilar Campo, Hidalgo Cardus, Gil Castello, Gloria Maria, Montsesinos Castrillo, Estopà Català, Garces Clave, Sanroma Comes, Sequi Descalzo, Ricol Errando, Campillo Escudero, del Mar Maria, Alvarez Fernandez, Gomez Fernandez, Perez Fernandez, Espinosa Franch, Graells Freixes, Plaza Garcia, Gallego Garcia-Marron, Simancas Hernandez, Covas Homar, Royo Huerta, Armas Jaraba, Ramos Jimenez, Canela Lopez, Angeles M, Lopez Lopez, Oganissian Lopez, Romero Madrona, Rosa M, Millan Martinez, Morón Martínez, Encinas Merchan, Fornieles Morell, Jimenez Moreno, Rico Muñoz, Rodriguez Navarro, Ibañez Nogales, Maria Rita, Viera Novillo, Torrabadella Parella, Alba Mari, Villar Pera, Montserrat Carla, Carbonell Puertas, Miralles Rabella, Trilles Ramis, Ortiz Ribera, Fuertes Rodriguez, Gonzalez Sanchez, Perez Sastre, Perez Segura, Borrega Soro, Garcia Soto, Angeles Maria, Fores Tapia, Bernad Tellez, Alvarez Trenado, Moreda Español, Martin Felix, Perez Herrero, Manzanera Jodar, Fuster Lanau, Gomariz Lopez, Orive Marrodan, Bosch Martin, Jose Maria, Guri Miralles, Oliva Muñoz, Lozano Pardo, Pujol Pons, Altimiras Quintana, Lopez Ventosa, Damian Almodovar, Colino Alvarez, Monterroso Alvarez, Comas Arambudo, Garzon Boullon, Capella Burgos, Garcia Campuzano, Del Mar Maria, Olivas Capdevila, Fernandez Carcelen, Solà Caro, Marti Carre, Isabel Clara, Bacaicoa Carretero, Gil Castello, Gloria Maria, Montsesinos Castrillo, Calderon Cazorla, Osuna Chacon, Planas Cortes, Olio Cortit, Estany Delhomme, Carasso Duran, Javier Pablo, Campillo Escudero, del Mar Maria, Martinez Fructuos, Lopez Garcia, Luis Pascual, Plaza Garcia, Amill Vallve Genis, Arroyo Gomez, Girbau Gomez, Muñoz Gonzalez, Ventura Hernaez, Covas Homar, Gimenez Lavernia, Rojo Martin, Medina Martínez, Millan Martinez, Barrera Mayol, Pi Mercader, Dalmau Merino, Campodarbe Miguel, Pastalle Montserrat Puig, de la Cruz Morales, Fornieles Morell, Sanchez Moreno, Javier Francisco, Reig Pallares, Torrabadella Parella, Mari Alba, Barrameda Penela, Ajenjo Prieto, Benavente Rebollar, Pareja Rodriguez, Piñar Rodríguez, Francisco Javier, Tello Rodriguez, Pereda Romero, Saborido Sainz, Martin Santacana, Martinez Santos, Chavez Sierra, Testa Toledo, Figueras Tomàs, Garcia Torres, José Pedro, Torres Turbau, Domenech Vicente, Esteo Villena, Pertegaz Vives, Gonzalez Baena, Pont Bagaria, Sanchez Beltran, Alarcon Bonet, Ballescà Borch, Clanchet Buhils, Garcia Closa, Carril Colomina, Sanchez Cristina Fernandez, Edurne Judith Fernandez Toledo, Rodriguez Espases, Resa Espert, Xavier F, Sol Fernández, Lugo Gonzalez, Llesera Gracia, Lendinez Herrada, Liesa Juliench, Alicia Sandra, Ortega Lopez, Yuste Lopez, Villanueva Lozano, Soto Lucia Sola, Castellano Madrid, Cano Megias, Jesus Daniel, Ponce Montasell, Sospedra Montesinos, Martinez Moya, Herrera Muñoz, Isabel M, Fernandez Ocaña, Jose Maria, Bernal Palau, Sole Perez, Carbonell Ramon, Lop Ribas, López Rubio, Lopez Rueda, Castaño Sabat, Lara Sabata, Ramírez Salmerón, Gornals Sebastia, Creus Serra, Dalmau Serrano, Mainero Sumasi, Gabriel Gonzalo, Masa Torello, Primo Valencia, Viñuales Muñoz Ana Maria, Roig Josep, Hidalgo. Verònica
Affiliation:
1. Department of Neurology, Stroke Unit, Hospital Universitari Vall d’Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo). 2. Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.). 3. Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.). 4. Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain (P.C.). 5. Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U.). 6. Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova de Lleida, Lleida, IRBLleida, UdL, Spain (F.P.). 7. Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain (Y.S.). 8. Department of Neurology, Stroke Unit, Hospital Joan XXIII, Tarragona, Spain (X.U.). 9. Department of Neurology, Stroke Unit, Hospital Verge de la Cinta, Tortosa, Spain (P.E.). 10. Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.). 11. Fundació Ictus, Barcelona, Spain (M.G.). 12. Neurological Institute, Cooper University Hospital, Camden, New Jersey (T.J.). 13. Catalan Health Institute (ICS), Barcelona, Spain (S.A.).
Abstract
Background:
We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion).
Methods:
Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics.
Results:
The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2–5] versus 3 [1–5], common odds ratio, 1.25 [95% CI, 1.06–1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08–1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81–1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16–1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51–0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25–52]) and thrombectomy(mean difference 66 minutes [95% CI, 37–95]).
Conclusions:
In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02795962.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
6 articles.
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