Mandated Prehospital Triage to Stroke Centers

Daniel J. Pallin, MD, MPH

The likelihood of timely thrombolysis at stroke centers increased after the mandate, but patients arriving at nonstroke centers were not studied.

Preferential transport to specialized centers has been found to be beneficial for trauma and myocardial infarction; it is now becoming increasingly common for stroke. Chicago initiated a citywide policy of preferential transport of stroke patients to primary stroke centers in March, 2011. Researchers reviewed a database from 10 of Chicago's 17 primary stroke centers, to determine how care differed before and after the policy change. Nonstroke centers were not included.

The odds of a stroke patient receiving tissue plasminogen activator after presenting to the emergency department were 2.2 times higher in the 6 months after the policy change than in the 6 months before, in an analysis that controlled for confounding by mode of arrival, prehospital notification, and symptom-onset-to-arrival time.

Citation(s):

Prabhakaran S et al. Prehospital triage to primary stroke centers and rate of stroke thrombolysis. JAMA Neurol 2013 Jul 1.