Objective:

Characterize differences in transfer timelines of urban and rural patients with large vessel occlusions (LVO) from last known normal (LKN) to groin-puncture for thrombectomy in Colorado.

Background:

Rural patients experience longer times to intervention than urban patients, leading to worse outcomes.

Design/Methods:

Clinical data were obtained from thrombectomy centers in Colorado. Wilcoxon rank sum test compared length and proportion of total time from LKN to groin-puncture for thrombectomy in four phases: LKN to spoke hospital arrival, arrival to departure at spoke hospital, spoke hospital departure to hub arrival, hub arrival to groin-puncture.

Results:

Patients presenting first to urban vs. rural hospitals spent similar length and proportion of time from LKN to spoke arrival (median 90 vs. 110 min, p=0.266; 35 vs. 38%, p=0.276, respectively). Proportion of time spent in the spoke hospital was higher for urban than rural patients (median 37 vs. 21.4%, p<0.001) while actual time was similar (97 vs. 105 min, p=0.517). Both proportion and length of time spent during transfer from spoke to hub was lower for urban vs. rural patients (median 8 vs. 13%, p<0.001; 26 vs. 50 min, p<0.001, respectively). Both proportion and length of time from hub arrival to groin-puncture were shorter for patients transferred from urban vs. rural spoke hospitals (median 11 vs. 14.9%, p=0.001; 34.5 vs. 56 min, p<0.001).

Conclusions:

While longer transfer times from rural hospitals were expected, the delays to groin puncture after hub arrival for rural patients revealed an unexplored barrier. Research is needed to determine if hub hospital care can be modified to mitigate differences.