Effects of EMS Trauma Designation on Stroke Treatment Times and Clinical Outcomes

Introduction Prehospital notifications from emergency medical services (EMS) are essential for timely stroke triage. However, patients triaged as trauma team activation (“trauma”), may inadvertently bypass stroke‐specific pathways, potentially delaying critical imaging and treatment. This study evaluated whether EMS notifications labeled as “trauma” impacted acute stroke treatment time‐metrics and functional outcomes compared to those labeled as “stroke”. Methods We conducted a retrospective analysis of a prospectively maintained dataset including patients who underwent mechanical thrombectomy (MT) for acute ischemic stroke (AIS) between January 2021 and January 2024 at two thrombectomy‐capable tertiary trauma centers. Patients were categorized into two groups‐based on EMS pre‐arrival notification designations: “stroke” or “trauma.” To minimize baseline imbalances, propensity score matching was performed at a 1:2 ratio, pairing trauma‐designated cases with stroke‐designated cases according to demographic and clinical covariates. Primary outcome measures included door‐to‐CT time (DTC), door‐to‐needle time (DTN), and door‐to‐puncture time (DTP), each reported as median (interquartile range [IQR]) in minutes. Secondary outcomes were favorable functional outcomes, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days, and 90‐day mortality. Results Among 284 patients presenting with prehospital notifications, 14 patients designated “trauma” activations and were matched to 28 patients designated as “stroke” activations (Table 1). The median age [IQR] was 64 [60.25, 76.25] and 74 [62.5, 83.25], Median baseline NIHSS was 16 [15, 20] and 16 [11, 19] in the “trauma” and “stroke" groups, respectively. Prehospital stroke severity scale (PSSS) was documented in 7.1% of “trauma" compared to 50% of “stroke" cases (p < 0.01). DTC, DTN, and DTP were significantly longer in the “trauma" compared to “stroke" cases (28 [20, 46] vs. 14.5 [10.8, 26.5], p <0.01),) and DTP times of 151.5 [129.3, 236.5] vs. 71.5 [62.8, 94.0] (p < 0.01), respectively. There were no significant differences in 90‐day mRS 0–2 and mortality between the two groups (33.3% vs. 36%, p > 0.9) and (35.7% vs. 21.4%, p = 0.1), respectively. Conclusion Patients with prehospital trauma designation experienced marked delays in MT that were disproportional to the delays in initial imaging, likely reflecting delays in assessment and subsequent medical decision‐making. Addressing systemic gaps and adopting parallel workflows for coexisting emergencies like trauma and stroke could streamline triage and prevent delays in administering time‐sensitive treatments.