Centrally Guided Identification of Patients With Large Vessel Occlusion: Lessons From Trauma Systems

Autor: Toby Gropen, Michael Minor, Melissa Gazi, Abimbola Fadairo, Joe E. Acker
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Emergency Medical Services
Inservice Training
Arterial Occlusive Diseases
Brain Ischemia
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
Emergency medical services
Humans
Suspected stroke
Stroke
Aged
NIH stroke scale
Receiver operating characteristic
business.industry
Emergency Medical Service Communication Systems
Rehabilitation
Significant difference
Reproducibility of Results
Middle Aged
medicine.disease
Prognosis
Confidence interval
stomatognathic diseases
Emergency Medical Technicians
Cardiology
Feasibility Studies
Surgery
Female
Neurology (clinical)
Clinical Competence
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Large vessel occlusion
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 28(9)
ISSN: 1532-8511
Popis: Objective: Improve prehospital identification of acute ischemic stroke patients with large vessel occlusion (LVO) by using a trauma system-based emergency communication center (ECC) to guide the emergency medical service (EMS). Methods: We trained 24 ECC paramedics in the Emergency Medical Stroke Assessment (EMSA). ECC-guided EMS in performance of the EMSA on patients with suspected stroke. During the second half of the study, we provided focused feedback to ECC after reviewing recorded ECC-EMS interactions. We compared the sensitivity, specificity, and area under the receiver operator characteristics curve (AUC) and 95% confidence interval of ECC-guided EMSA to the NIH Stroke Scale (NIHSS) for predicting a discharge diagnosis of LVO. Results: We enrolled 569 patients from September 2016 through February 2018. Of 463 patients analyzed, 236 (51%) had a discharge diagnosis of stroke and 227 (49%) had a nonstroke diagnosis. There were 45 (19%) stroke patients with LVO. For predicting LVO, there was no significant difference between the EMSA AUC = .68 (.59-.77) and the NIHSS AUC = .73 (.65-.81). An EMSA score greater than or equal to 4 had sensitivity = 75.6 (60.5-87.1) and specificity = 62.4 (57.6-67.1) for LVO. During the first 9 months of the study, the EMSA AUC = .61 (.44-.77) compared to an AUC = .74 (.64-.84) during the second 9 months. Conclusions: ECC-guided prehospital EMSA is feasible, has similar ability to predict LVO compared to the NIHSS, and has sustained performance over time.
Databáze: OpenAIRE
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