Influence of geography, stroke timing, and weather conditions on transport and workflow times: Results from a longitudinal 5-year Canadian provincial registry
Nima Kashani, Johanna Maria Ospel, Nishita Singh, Amy Zhou, Aravind Ganesh, Jessalyn Kathryn Holodinsky, Mohammed Almekhlafi, Saman Fouladirad, Adam Frost, Lotus Yang, Robert Otani, Braedon Newton, Amit Persad, Sanchea Wasyliw, Brett R Graham, Gary Hunter, Aaron Gardner, Regan Cooley, Syed Uzair Ahmed, Lissa Peeling, Michael E Kelly- General Medicine
Background
In areas with high population spread such as Saskatchewan, it can be challenging to provide timely endovascular stroke treatment (EVT) to patients living far away from comprehensive stroke centres (CSC). We assessed the association of geography, stroke timing and weather conditions on EVT workflow times and clinical outcomes in Saskatchewan.
Methods
We included patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan, Canada. Univariable and multivariable associations of time from last known well-to-CSC arrival, CSC arrival-to-reperfusion, and 90-day modified Rankin Score (mRS) with driving distance from patient home to CSC, transport mode, outdoor temperature and stroke timing (day & time) were assessed using descriptive statistics and multivariable regression.
Results
Three-hundred-three patients in the province of Saskatchewan underwent EVT between January 2017 and December 2022. Distance from patient home to CSC (beta-coefficient per 10 km increase = 0.02, 95% CI: 0.01–0.03) and direct to CSC transport (beta-coefficient = −0.76, 95% CI = −1.01–[−0.51]) were associated with last known well to CSC arrival time. In-hospital stroke (beta-coefficient = 0.37, 95% CI: 0.16–0.58), direct-to-CSC transfer (beta-coefficient = 0.27, 95% CI: 0.13–0.41) and daytime stroke onset (beta-coefficient = −0.15, 95% CI: −0.28–[−0.04]) were associated with time from CSC arrival to reperfusion. No association with 90-day mRS was seen.
Conclusion
Geographic factors and stroke timing were associated with EVT workflow times. However, no association with clinical outcomes was seen, suggesting that EVT patients living remote areas of Saskatchewan have similar benefit from EVT compared to urban areas. Every effort should be made to offer timely EVT to patients from remote areas.