Electronic Alberta Stroke Program Early CT score change and functional outcome in a drip-and-ship stroke service

Background: Debate continues as to whether patients with acute ischemic stroke with (suspected) large vessel occlusion benefit from direct referral versus secondary transportation.

Aims: To analyze the change in early infarct signs, collaterals, and acute ischemia volume and their association with transfer time and functional outcome.

Methods: Consecutive transfers between 2013 and 2016 of anterior circulation stroke patients transported from referring hospitals as potential thrombectomy candidates were retrospectively analyzed. ASPECTS was automatically calculated on external and in-house CT using Brainomix e-ASPECTS, collaterals were assessed using e-CTA, and 3-month mRS was obtained.

Results: 102 patients with CT at both the referring hospital and the center were identified. During transfer, e-ASPECTS declined by a median of 1 point, and functional outcome correlated with the change in e-ASPECTS. Median image-to-image time was 149 min but did not correlate with e-ASPECTS change or 3-month mRS. Preserved good collateral status was associated with better functional outcome.

Conclusions: Patient transfer in a drip-and-ship network was associated with declines in e-ASPECTS associated with worse functional outcome. Image-to-image time did not influence this association, but worsening collateral status did.