Workflow and factors associated with delay in the delivery of intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial

Esmee Venema, Nikki Boodt, Olvert A Berkhemer, Pleunie P M Rood, Wim H van Zwam, Robert J van Oostenbrugge, Aad van der Lugt, Yvo B W E M Roos, Charles B L M Majoie, Hester F Lingsma, Diederik W J Dippel, MR CLEAN Investigators

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: The effect of intra-arterial treatment (IAT) for acute ischemic stroke is highly time-dependent. We investigated the delay of IAT and factors associated with such delay.

METHODS: MR CLEAN was a randomized trial of IAT plus usual care versus usual care alone (n=500). With multivariable linear regression, we analyzed the effect of intravenous treatment, general anesthesia, off-hours and inter-hospital transfer on time to admission to the emergency department (ED) of the intervention center and time to treatment. Furthermore, we assessed compliance with a target of 75 min for time from ED to treatment, and calculated the potential absolute increase in the number of patients with a good outcome (modified Rankin Scale score ≤2) if this target had been achieved in all treated patients.

RESULTS: Inter-hospital transfer prolonged time to ED by 140 min (95% CI 129 to 150) but reduced time from ED to treatment by 77 min (95% CI 64 to 91). Time from ED to treatment was increased by 19 min by general anesthesia (95% CI 5 to 33) and total time was increased by 23 min during off-hours (95% CI 6 to 40). The in-hospital target was achieved in 11.5% (22/192) of patients. Full compliance with the target time of 75 min from ED to treatment would have increased the proportion of patients with a good outcome by 7.6% (95% CI 6.7% to 8.5%).

CONCLUSION: Inter-hospital transfer is an important cause of delay in the delivery of IAT and every effort should be made to avoid transfers and reduce transfer-related delay. Furthermore, in-hospital workflow should be optimized to improve functional outcome after IAT.

Original languageEnglish
Pages (from-to)424-428
Number of pages5
JournalJournal of neurointerventional surgery
Volume10
Issue number5
DOIs
Publication statusPublished - May 2018

Cite this

Venema, E., Boodt, N., Berkhemer, O. A., Rood, P. P. M., van Zwam, W. H., van Oostenbrugge, R. J., ... MR CLEAN Investigators (2018). Workflow and factors associated with delay in the delivery of intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial. Journal of neurointerventional surgery, 10(5), 424-428. https://doi.org/10.1136/neurintsurg-2017-013198