The Hunter-8 Scale Prehospital Triage Workflow for Identification of Large Vessel Occlusion and Brain Haemorrhage.

Autor:	Garcia-Esperon C; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.; College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; Hunter Medical Research Institute, Newcastle, New South Wales, Australia., Ostman C; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.; College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia., Walker FR; College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; Hunter Medical Research Institute, Newcastle, New South Wales, Australia., Chew BLA; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia., Edwards S; New South Wales Ambulance, Rozelle, New South Wales, Australia., Emery J; New South Wales Ambulance, Rozelle, New South Wales, Australia., Bendall J; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.; New South Wales Ambulance, Rozelle, New South Wales, Australia., Alanati K; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia., Dunkerton S; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia., Starling de Barros R; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia., Amin M; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia., Gangadharan S; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia., Lillicrap T; Hunter Medical Research Institute, Newcastle, New South Wales, Australia., Parsons M; College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.; Department of Neurology, University of New South Wales South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia., Levi CR; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.; College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; Hunter Medical Research Institute, Newcastle, New South Wales, Australia., Spratt NJ; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.; College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
Jazyk:	angličtina
Zdroj:	Prehospital emergency care [Prehosp Emerg Care] 2023; Vol. 27 (5), pp. 623-629. Date of Electronic Publication: 2022 Sep 26.
DOI:	10.1080/10903127.2022.2120134
Abstrakt:	Objective: The Hunter-8 prehospital stroke scale predicts large vessel occlusion in hyperacute ischemic stroke patients (LVO) at hospital admission. We wished to test its performance in the hands of paramedics as part of a prehospital triage algorithm. We aimed to determine (a) the proportion of patients identified by the Hunter-8 algorithm, receiving reperfusion therapies, (b) whether a call to stroke team improved this, and (c) performance for LVO detection using an expanded LVO definition. Methods: A prehospital workflow combining pre-morbid functional status, time from symptom onset, and the Hunter-8 scale was implemented from July 2019. A telephone call to the stroke team was prompted for potential treatment candidates. Classic LVO was defined as a proximal middle cerebral artery (MCA-M1), terminal internal carotid artery, or tandem occlusion. Extended LVO added proximal MCA-M2 and basilar occlusions. Results: From July 2019 to April 2021, there were 363 Hunter-8 activations, 320 analyzed: 181 (56.6%) had confirmed ischemic strokes, 13 (4.1%) transient ischemic attack, 91 (28.5%) stroke mimics, and 35 (10.9%) intracranial hemorrhage. Fifty-two patients (16.3%) received reperfusion therapies, 35 with Hunter-8 ≥ 8. The stroke doctor changed the final destination for 76 patients (23.7%), and five received reperfusion therapies. The AUCs for classic and extended LVO were 0.73 (95% CI 0.66-0.79) and 0.72 (95% CI 0.65-0.77), respectively. Conclusion: The Hunter-8 workflow resulted in 28.7% of confirmed ischemic stroke patients receiving reperfusion therapies, with no secondary transfers to the comprehensive stroke center. The role of communication with stroke team needs to be further explored.
Databáze:	MEDLINE
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