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

Autor:	Garcia-Esperon, C., Ostman, C., Walker, F. R., Chew, B. L. A., Edwards, S., Emery, J., Bendall, J., Alanati, K., Dunkerton, S., Starling de Barros, R., Amin, M., Gangadharan, S., Lillicrap, T., Parsons, M., Levi, C. R., Spratt, N. J.
Předmět:	TRANSIENT ischemic attack diagnosis CAROTID artery ARTERIAL occlusions MEDICAL triage CEREBRAL hemorrhage CONFIDENCE intervals SCIENTIFIC observation ISCHEMIC stroke NIH Stroke Scale MANN Whitney U Test WORKFLOW CEREBRAL arteries BASILAR artery EMERGENCY medical services DESCRIPTIVE statistics CHI-squared test RESEARCH funding SENSITIVITY & specificity (Statistics) REPERFUSION RECEIVER operating characteristic curves DATA analysis software EMERGENCY medicine ALGORITHMS CEREBRAL ischemia LONGITUDINAL method
Zdroj:	Prehospital Emergency Care; 2023, Vol. 27 Issue 5, p623-629, 7p
Abstrakt:	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. 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. 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. 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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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