Objective:

We sought to determine the impact of Prehospital Stroke Severity Scale (PSSS) acquisition on acute ischemic stroke (AIS) treatment times among non-urban patients with Large Vessel occlusion (LVO) undergoing Mechanical Thrombectomy (MT) in our healthcare system.

Background:

Our statewide Emergency Medical Services (EMS) protocols recommend that a validated PSSS should be administered on patients with suspected stroke to determine the optimal stroke facility destination.

Design/Methods:

This is a retrospective analysis of a prospectively maintained database of AIS patients between January 2021 and October 2023. We included consecutive patients with LVO who presented with pre-arrival notifications via EMS either directly to one of our two Comprehensive Stroke Centers (CSC) or were transferred from one of 11 Primary Stroke Centers (PSC) within our telestroke network to a CSC and underwent MT. Patients who presented directly to the CSC and were within 30 minutes of driving distance were excluded. This cohort was divided into two groups: patients with PSSS(P+) and those without PSSS(P-). Primary outcomes were First Medical contact to Arterial Puncture time (FMC-to-AP) and First Medical Contact to Intravenous thrombolysis time (FMC-to-IVT). The Mann-Whitney U test was used to assess significant differences in continuous variables between the two groups.

Results:

225 patients were included. Median age was 72 years [IQR 62–81]; 40% were male; median NIHSS was 17 [IQR 12–22]. PSSS was acquired in 103(45.8%) patients. (P+) group had shorter FMC-to-AP (137 minutes [IQR 112–188] vs 169 minutes [IQR 130–211]; p 0.01), whereas the FMC-to-IVT was similar in both groups (83.0 minutes [IQR 74.5–89.5] vs 91 minutes [IQR 69–113]; p=0.3).

Conclusions:

PSSS acquisition was associated with shorter FMC-to-AP without any significant impact on the FMC-to-IVT. More research is needed to investigate the impact of PSSS acquisition in the field on AIS treatment times across large healthcare systems.