Comparison of Prehospital Assessment by Paramedics and In-Hospital Assessment by Physicians in Suspected Stroke Patients: Results From 2 Prospective Cohort Studies.
| Autor: | Dekker L; Department of Neurology (L.D., T.T.M.N., I.R.v.d.W., M.J.H.W., N.D.K.), Leiden University Medical Center, the Netherlands., Daems JD; Department of Neurology (J.D.D., M.H.C.D., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.; Department of Public Health (J.D.D., E.V.), Erasmus MC University Medical Center, Rotterdam, the Netherlands., Duvekot MHC; Department of Neurology (J.D.D., M.H.C.D., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.; Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., A.D.R., H.K.)., Nguyen TTM; Department of Neurology (L.D., T.T.M.N., I.R.v.d.W., M.J.H.W., N.D.K.), Leiden University Medical Center, the Netherlands., Venema E; Department of Public Health (J.D.D., E.V.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.; Department of Emergency Medicine (E.V.), Erasmus MC University Medical Center, Rotterdam, the Netherlands., van Es ACGM; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands., Rozeman AD; Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., A.D.R., H.K.)., Moudrous W; Department of Neurology (W.M.), Maasstad Hospital, Rotterdam, the Netherlands., Dorresteijn KRIS; Department of Neurology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands (K.R.I.S.D.)., Hensen JJ; Department of Radiology (J.-H.J.H.), Maasstad Hospital, Rotterdam, the Netherlands., Bosch J; Emergency Medical Services Hollands-Midden, Leiden, the Netherlands (J.B.)., van Zwet EW; Department of Medical Statistics (E.W.v.Z.), Leiden University Medical Center, the Netherlands., de Schryver ELLM; Department of Neurology, Alrijne Hospital, Leiderdorp, the Netherlands (E.L.L.M.d.S.)., Kloos LMH; Department of Neurology, Groene Hart Hospital, Gouda, the Netherlands (L.M.H.K.)., de Laat KF; Department of Neurology, Haga Hospital, The Hague, the Netherlands (K.F.d.L.)., Aerden LAM; Department of Neurology, Reinier de Graaf Gasthuis Hospital, Delft, the Netherlands (L.A.M.A.)., van den Wijngaard IR; Department of Neurology (L.D., T.T.M.N., I.R.v.d.W., M.J.H.W., N.D.K.), Leiden University Medical Center, the Netherlands., Dippel DWJ; Department of Neurology (J.D.D., M.H.C.D., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands., Kerkhoff H; Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., A.D.R., H.K.)., Wermer MJH; Department of Neurology (L.D., T.T.M.N., I.R.v.d.W., M.J.H.W., N.D.K.), Leiden University Medical Center, the Netherlands.; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (M.J.H.W.)., Roozenbeek B; Department of Neurology (J.D.D., M.H.C.D., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands., Kruyt ND; Department of Neurology (L.D., T.T.M.N., I.R.v.d.W., M.J.H.W., N.D.K.), Leiden University Medical Center, the Netherlands. |
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| Jazyk: | angličtina |
| Zdroj: | Stroke [Stroke] 2023 Sep; Vol. 54 (9), pp. 2279-2285. Date of Electronic Publication: 2023 Jul 19. |
| DOI: | 10.1161/STROKEAHA.123.042644 |
| Abstrakt: | Background: It is unknown if ambulance paramedics adequately assess neurological deficits used for prehospital stroke scales to detect anterior large-vessel occlusions. We aimed to compare prehospital assessment of these stroke-related deficits by paramedics with in-hospital assessment by physicians. Methods: We used data from 2 prospective cohort studies: the LPSS (Leiden Prehospital Stroke Study) and PRESTO study (Prehospital Triage of Patients With Suspected Stroke). In both studies, paramedics scored 9 neurological deficits in stroke code patients in the field. Trained physicians scored the National Institutes of Health Stroke Scale (NIHSS) at hospital presentation. Patients with transient ischemic attack were excluded because of the transient nature of symptoms. Spearman rank correlation coefficient (r Results: We included 2850 stroke code patients. Of these, 1528 had ischemic stroke, 243 intracranial hemorrhage, and 1079 stroke mimics. Correlation between the total prehospital assessment score and NIHSS score was strong (r Conclusions: The overall prehospital assessment of stroke code patients correlates strongly with in-hospital assessment. Prehospital assessment of neglect, abnormal speech, and gaze deviation differed most from in-hospital assessment. Focused training on these deficits may improve prehospital triage. Competing Interests: Disclosures Dr Kruyt reported receiving grant HA20 15.01.02 from the Dutch Brain Foundation, grant 3.240 from the Dutch Innovation Funds, and grant LSHM16041 from Health~Holland during the conduct of the study. Dr Roozenbeek reported funding from the Dutch Heart Foundation and the Netherlands Organization for Health Research and Development (ZonMw) during the conduct of this study, paid to the institution. Dr Wermer reported receiving Clinical Established Investigator grant 2016T086 from the Dutch Heart Foundation and VIDI grant 9171337 from the Netherlands Organization for Health Research and Development (ZonMw) during the conduct of the original LPSS study (Leiden Prehospital Stroke Study). Dr Dippel reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, the Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences and Health, and unrestricted grants from Penumbra Inc, Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to institution outside the submitted work. Dr van den Wijngaard reports compensation from Philips and Medtronic for consultant services, and stock holdings in Neurophyxia BV. The other authors report no conflicts. |
| Databáze: | MEDLINE |
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