North Bristol Trust: Thrombectomy Referral Criteria – External Hospitals

Referrals will be received from other hospitals Monday to Sunday, 8 am to 5 pm.

Patients referred must be able to arrive at Southmead by 6 pm.

Referrals should be made in person by a stroke consultant to the North Bristol Trust thrombectomy physician via the thrombectomy phone, the number for which has been provided to each referring centre.

Phone number: 07784 359723                                                        

Alternatively, the thrombectomy phone can be reached through NBT switchboard: call 0117 9505050 and ask for “Thrombectomy Consultant on Call”.

In case of difficulties, alternative contacts are stroke consultant bleep 1290, stroke registrar bleep 1490, or neurology registrar bleep 1636.

Before referral, the following should have been carried out:

  • Upload of all new brain imaging to cloud portal (Biotronics 3Dnet).
  • Completion of referral via referapatient: www.referapatient.org 
  • Where intravenous thrombolysis is indicated this should not be delayed

Referrals should fulfil all of the following criteria:

Clinical

  • NIHSS >= 6 or disabling/fluctuating deficit
  • Independent before the index stroke (modified Rankin Scale 0-2).
  • Fit for emergency transfer. If concerns exist regarding patients being safe for inter-hospital transfer seek advice from local anaesthetic / critical care team
  • Sufficiently well to benefit from treatment. This includes co-morbidities and frailty; while age influences fitness for treatment age does not by itself limit capacity to benefit.

 

Radiological

  • All patients should undergo a NCCT and CTA with coverage from aortic arch to the vertex*
    • This should be uploaded to Biotronics 3DNet routinely,
    • This should have a local diagnosis of an LVO (carotid-T, M1, proximal M2 or tandem occlusions) via a consultant radiologist or automated post processing tool such as Rapid or Brainomix.

*Multi or dual phase CT angiography is preferred.

  • For patients arriving at Southmead within 6 hours:
    • NCCT and CT angiography is required.

 

  • For patients arriving at Southmead within 12 hours:
    • NCCT and CT angiography is required. 
    • Minimal early ischaemic change required (defined as NCCT ASPECTS >= 5 if perfusion imaging is not available locally).
    • Additional CT perfusion with automated post processing is preferable.

 

  • For patients arriving at Southmead between 12 and 24 hours:
    • NCCT, CT angiography and CT perfusion is required. 

NOTE:   If a patient does not fulfil the above criteria but it is felt that they would benefit from treatment, for example young patient with large ischaemic core, basilar occlusion, referrals will still be considered.

Please  ensure a ReSPECT  form has been completed prior to transfer

 

 

North Bristol Trust: Thrombectomy Referral Criteria – External Hospitals