The Effect of a County Prehospital FAST-ED Initiative on Endovascular Treatment Times
| Autor: | Virginia Ramos, Helen Rynor, Amy Starosciak, Felipe De Los Rios La Rosa, Ivis Gonzalez, Emir Veledar, Anshul Saxena, Maygret Ramirez, Joseph Souchak, Ned Shashoua, Jake Levine |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Emergency Medical Services Time Factors Concordance Stroke severity Time-to-Treatment 03 medical and health sciences 0302 clinical medicine After-Hours Care medicine Humans Thrombolytic Therapy Prospective Studies Endovascular treatment Stroke Acute stroke Aged Retrospective Studies Aged 80 and over business.industry Rehabilitation Field assessment Endovascular Procedures Middle Aged medicine.disease Triage Treatment Outcome Emergency medicine Florida Surgery Female Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Large vessel occlusion Program Evaluation |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 29(11) |
| ISSN: | 1532-8511 |
| Popis: | Acute stroke outcomes depend on timely reperfusion. In 3/2017, local EMS agencies implemented a prehospital triage algorithm with hospital bypass and field activation of the neurointerventional team using the Field Assessment Stroke Triage for Emergency Destination (FAST-ED). A score ≥4 bypasses to a comprehensive stroke center (CSC) and a score ≥6 also has the interventional team field activated off-hours.We analyzed effects of this initiative on volume, acute stroke transfers, treatment times, and outcomes and determined the tool's ability to predict large vessel occlusion.Stroke cases brought to our center by EMS during 3/2016-2/2018 were analyzed, which included one year before and after FAST-ED implementation. Treatment times were compared on- vs. off-hours and to those with field activation.Of 1153 patients, 761 (67%) were coded as stroke and 235 (20%) underwent reperfusion. Age, sex, race/ethnicity, stroke severity, length of stay, door-to-needle, and 90-d mRS were comparable between periods. Scale compliance was 85%. Concordance rate of ±1 between EMS and calculated score was 53%. Compared to the previous year, door-to-puncture (DTP) improved by 17 min (p 0.01) overall, 25 min (p 0.001) off-hours, and 33 min (p 0.05) with field activation. A cutoff of 4 vs. 6 would have led to 140% increase in field activations but only 36% increase in procedures.This prehospital initiative led to faster DTP by up to 33 min. The highest impact was off-hours with field activation. Only 1/3 of activations led to endovascular treatment. FAST-ED≥6 appears to be appropriate for field activation. |
| Databáze: | OpenAIRE |
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