To compare the difference in door to groin puncture time (DGPT) before and after incorporating Ventura ELVO Score (VES) protocol at our center.

The outcome of mechanical thrombectomy for emergent large vessel occlusion (ELVO) in patients with acute ischemic stroke (AIS) is time dependent. The most common delay in DGPT is pre-hospital delay.

VES was implemented in the Ventura county of California in conjunction by paramedics to improve the triage process. We performed retrospective analysis to compare DGPT of patients undergoing mechanical thrombectomy pre and post-VES implementation. Mean and standard deviation were reported for the continuous variable ‘time for intra-arterial thrombectomy (IAT)’ in minutes. Normality was assessed using the Shapiro-Wilk’s test which indicated that the variable is not normally distributed, therefore, Mann-Whitney U-test was used for the comparison of the variable between the two groups. P-value of ≤ 0.05 was considered statistically significant for all the tests. All the analyses were performed using SAS v9.4.

Total of 304 patients were alerted for the code stroke by the EMS. N=162 (53%) were females. Out of 304 code stroke patients, VES was positive in 139 patients. Out of those who were positive for VES, N=75 (54%) were females. Among these, the VES score of 1, 2, 3, and 4 were recorded in 57 (41%), 44 (31.6%), 31 (22.3%), and 7 (5%) patients respectively. A total of 48 patients who were positive for VES underwent IAT. There were 62 patients who underwent intra-arterial thrombectomy before the implementation of VES protocol. The mean DGPT for the IAT among post-VES patients was 65 minutes, which was significantly (p=0.0009) less than mean DGPT of 109 minutes among pre-VES patients.

VES showed higher sensitivity, specificity, positive predictive value, negative predictive value and accuracy. The results showed significantly reduced DGPT among post-VES patients as compared to pre-VES patients.