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Does Adding Thrombectomy-Capable Stroke Centers in a Regional Stroke Care System Affect Procedural Volume?

Published online by Cambridge University Press:  16 April 2025

Juliana Tolles Open the ORCID record for Juliana Tolles [Opens in a new window] ,
Jake Toy Open the ORCID record for Jake Toy [Opens in a new window] ,
Patrick Lyden ,
Marianne Gausche-Hill  and
Nichole Bosson
Juliana Tolles*
Affiliation:
Department of Emergency Medicine, Harbor-UCLA Medical Center & The Lundquist Institute, Torrance, California USA David Geffen School of Medicine at UCLA, Los Angeles, California USA
Jake Toy
Affiliation:
Department of Emergency Medicine, Harbor-UCLA Medical Center & The Lundquist Institute, Torrance, California USA David Geffen School of Medicine at UCLA, Los Angeles, California USA Los Angeles Emergency Medical Services Agency, Santa Fe Springs, California USA
Patrick Lyden
Affiliation:
Zilkha Neurogenetic Institute of the Keck University School of Medicine at USC, Los Angeles, California USA
Marianne Gausche-Hill
Affiliation:
Department of Emergency Medicine, Harbor-UCLA Medical Center & The Lundquist Institute, Torrance, California USA David Geffen School of Medicine at UCLA, Los Angeles, California USA
Nichole Bosson
Affiliation:
Department of Emergency Medicine, Harbor-UCLA Medical Center & The Lundquist Institute, Torrance, California USA David Geffen School of Medicine at UCLA, Los Angeles, California USA Los Angeles Emergency Medical Services Agency, Santa Fe Springs, California USA
*
Correspondence: Juliana Tolles, MD, MHS Department of Emergency Medicine Harbor-UCLA Medical Center & The Lundquist Institute 1000 W Carson St.Torrance, California USA 90502 E-mail: [email protected]
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Abstract

Background:

To maintain procedural proficiency and certification according to the standards set by The Joint Commission—which accredits health care centers in the United States—thrombectomy-capable stroke centers (TSCs) must achieve a minimum annual procedural volume. The addition of thrombectomy-capable centers in a regional stroke care system has the potential to increase access but also to decrease patient presentations and procedural volume at nearby centers. This study sought to characterize the impact of certifying additional thrombectomy-capable centers on procedural volume by center in a large, urban Emergency Medical Services (EMS) system.

Methods:

Data were collected from each designated thrombectomy-capable center in Los Angeles (LA) County from January 1, 2018 through June 30, 2022, during which a net total of five thrombectomy-capable centers were newly designated in the County. Per center volume for ischemic stroke presentations, intravenous (IV) thrombolysis administrations (IV tissue plasminogen activator [tPA]), and thrombectomy were tabulated by six-month interval. Median last-known-well-to-procedure times by LA County Public Health service planning area (SPA) were calculated. The effect of the number of designated centers on procedural volumes per center and median last-known-well-to-procedure times were analyzed via a linear mixed effects model with a log link function.

Results:

Procedural volume, ischemic stroke presentation volume, and last-known-well-to-procedure times had high variability over the time period studied. Nonetheless, the median values for each metric in this EMS system remained largely stable over the study period. There was no statistically significant association between the number of thrombectomy-capable centers and per center procedural volumes or times-to-procedure.

Conclusion:

The designation of additional thrombectomy-capable centers in a regional stroke care system was not significantly associated with the volume of procedures by center or times-to-procedure, suggesting that additional centers may increase patient access to time-sensitive interventions without diluting patient presentations at existing centers.

Keywords

large vessel occlusionregional carestrokethrombectomytPA
Type
Innovation Report
Information
Prehospital and Disaster Medicine , Volume 40 , Issue 2 , April 2025 , pp. 119 - 123
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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