Audit of stroke retrievals by Careflight Northern Operations and subsequent treatment in hospital

Dr Swati Gupta¹, Dr Katherine  Jeffrey, Dr John Roe

¹University Hospital Bristol and Weston, Bristol, United Kingdom

Thrombectomy is the standard of care in the treatment of large vessel occlusion stroke, and trials have shown that the time frame that is suitable for this treatment may be up to 24 hours. (1) Currently the Northern Territory is one of two states in Australia without an endovascular clot retrieval service. (2) The Stroke Foundation postulates that no stroke should be untreated. (3) In light of this, the study aimed to look at the numbers, time-metrics, and treatment (thrombolysis, transfer to endovascular retrieval centre, or neither) of patients retrieved for stroke in the Northern Territory via Careflight. A retrospective search of the Careflight database from September 2015 to September 2019 cross-referenced with Royal Darwin Hospital data revealed 60 cases of ischaemic stroke retrieved by Careflight in the Northern Territory. The average time from notification to first patient contact was 2 hours 22 minutes (range 35 minutes to 6 hours 53 minutes). Only 2/60 patients arrived in hospital within the 4.5-hour window necessary for thrombolysis. 37/60 patients arrived in hospital for assessment within 24 hours of symptom onset. 12/60 were of unknown timing, and a further 11/60 were beyond 24 hours of symptom onset. Patients were assessed in the emergency department and none of them had thrombolysis or referral for thrombectomy elsewhere. The average length of stay in hospital was 27 days. In conclusion, four years of data demonstrated no hyperacute reperfusion treatment for ischaemic stroke patients retrieved in the Northern Territory.

1Nogueira RG, Jadhav AP, Haussen DC et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. New england journal of medicine. 2018; 378: 11-21.

2National stroke audit. Acute services report. 2019. Strokefoundation.org.au

3No Postcode Untouched. Stroke in Australia 2017. Stroke Foundation. Accessed on: http://maps.strokefoundation.com.au/wpcontent/

themes/dlstroke/downloads/NoPostcodeUntouched_FullReport_2017.pdf on 28/09/2019

Biography:

Dr Jeffrey is a Retrieval Consultant with CareFlight Northern Territory since 2020. She is a Consultant Anaesthetist based in Sydney who specialises in Trauma/Neurosurgery and high acuity patients. Her research focus is improving outcomes for patients with trauma or neurological insults.