Clinical Significance of Prehospital Telecommunication Defined as the Critical Stroke Call Pathway in Acute Ischemic Stroke Requiring Intra-Arterial Recanalization Therapy

H. Lee; S.H. Kim; J.W. Baek; S.-C. Jin

doi:10.3174/ajnr.A7516

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FIG 1.
Flow diagrams of the RSP and the CSCP.
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FIG 2.
Receiver operating characteristic curve of the initial NIHSS score for prediction of a good clinical outcome (mRS = 0–2) at 90 days. The area under the curve of the NIHSS score was 0.714.
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FIG 3.
Graph comparing the 90-day mRS scores of the CSCP group and RSP group in the low NIHSS score (≤11 points) group.

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Table 1:

Comparison of baseline characteristics, time of treatment stage, and clinical and radiologic outcomes between CSCP and RSP

Characteristic	Patients		P Value
Characteristic	CSCP (n = 75)	RSP (n = 96)	P Value
Age (median) (IQR) (yr)	74 (65–80)	75 (63–81)	.932^{^a}
Male (No.) (%)	36 (48.0)	50 (48.3)	.596^{^b}
Diabetes mellitus (No.) (%)	18 (24.0)	22 (22.9)	.868^{^b}
Hypertension (No.) (%)	39 (52.0)	54 (56.3)	.580^{^b}
Dyslipidemia (No.) (%)	8 (10.7)	15 (15.6)	.346^{^b}
Atrial fibrillation (No.) (%)	24 (32.0)	24 (25.0)	.312^{^b}
CAOD (No.) (%)	11 (10.5)	13 (13.5)	.834^{^b}
Occlusion location (right) (No.) (%)	35 (46.7)	49 (51.0)	.570^{^b}
Initial NIHSS score (median) (IQR)	14 (8–18)	12 (8–15)	.049^{^a}
Time of treatment stage
Symptom onset to hospital arrival (median) (IQR) (min)	171 (55–544)	92 (42–258)	.082^{^a}
Door to puncture (median) (IQR) (min)	87 (63–107)	142 (106–177)	<.001^{^a}
Symptom onset to puncture (median) (IQR) (min)	268 (145–665)	254 (184–490)	.466^{^a}
Procedure time (median) (IQR) (min)	65 (49–86)	59 (40–85)	.200^{^a}
Radiologic and clinical outcome (No.) (%)
Successful recanalization (TICI 2b, 3)	64 (85.3)	79 (82.3)	.594^{^b}
Good clinical outcome (3-m mRS 0–2)	44 (58.7)	59 (61.5)	.711^{^b}
Excellent clinical outcome (3-m mRS 0–1)	32 (42.7)	35 (36.5)	.409^{^b}

Note:—CAOD indicates coronary artery occlusive disease; 3-m mRS, 3-month mRS.
↵a P value obtained using the Mann-Whitney U test.
↵b P value obtained using the Pearson χ² test.

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Table 2:

Comparison of baseline characteristics, time of treatment stage, and clinical and radiologic outcomes between the good clinical outcome group and the poor clinical outcome group

Characteristic	Patients		P Value
Characteristic	Good Clinical Outcome (n = 103)	Poor Clinical Outcome (n = 68)	P Value
Age (median) (IQR) (yr)	73 (62–78)	78 (66–83)	.007^{^a}
Male (No.) (%)	55 (53.4)	31 (45.6)	.317^{^b}
Diabetes mellitus (No.) (%)	23 (22.3)	17 (25.0)	.686^{^b}
Hypertension (No.) (%)	59 (57.3)	34 (50.0)	.349^{^b}
Dyslipidemia (No.) (%)	14 (13.6)	9 (13.2)	.947^{^b}
Atrial fibrillation (No.) (%)	33 (32.0)	15 (22.1)	.155^{^b}
CAOD (No.) (%)	18 (17.5)	6 (8.8)	.111^{^b}
Occlusion location (right) (No.) (%)	47 (45.6)	37 (54.4)	.261^{^b}
Initial NIHSS score (median) (IQR)	10 (7–14)	14 (12–18)	<.001^{^a}
Time of treatment stage
Symptom onset to hospital arrival (median) (IQR) (min)	120 (46–330)	122 (46–433)	.891^{^a}
Door to puncture (median) (IQR) (min)	108 (83–147)	109 (83–157)	.595^{^a}
Symptom onset to puncture (median) (IQR) (min)	255 (160–515)	254 (171–643)	.612^{^a}
Procedure time (median) (IQR) (min)	60 (44–85)	65 (44–86)	.925^{^a}
Successful recanalization	91 (88.3)	52 (76.5)	.040^{^b}

Note:—CAOD indicates coronary artery occlusive disease.
↵a P value obtained using the Mann-Whitney U test.
↵b P value obtained using the Pearson χ² test.

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Table 3:

Multivariable logistic regression analysis of good clinical outcome

	Adjusted OR	Adjusted 95% CI	P Value
Door-to-puncture time	0.998	0.996–1.000	.027
Initial NIHSS score	0.790	0.722–0.865	<.001
Successful recanalization	4.102	1.501–11.211	.006
Occlusion location (right: 1 or left: 2)	2.687	1.215–5.939	.015
Atrial fibrillation	2.602	1.139–5.941	.023