Impact of Prehospital Triage Scales to Detect Large Vessel Occlusion on Resource Utilization and Time to Treatment

Stroke; a Journal of Cerebral Circulation
Ludwig SchlemmMatthias Endres

Abstract

Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale. Compared with transporting each patient to the nearest stroke center, implementation of a prehospital triage strategy based on a rapid arterial occlusion evaluation scale cutoff score ≥5 is associated with more patients with suspected acute stroke at comprehensive stroke centers and less patients at primary stroke centers (+11.7% [95% confidence interval: +8.1% to +15.3%] and -18.4% [-19.1% to -17.7%], respectively). Mean time to groin puncture is reduced by 29.6 minutes (-35.2 to -24.7 minutes) while mean time to thrombolysis does not change significantly (±0.0 minutes [-0.3 to +0....Continue Reading

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Citations

Mar 23, 2019·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Priya NarwalShadi Yaghi
Jun 14, 2019·Journal of the American Heart Association·Ludwig SchlemmEckhard Schlemm
Dec 24, 2018·Journal of Neurointerventional Surgery·David CarreraUNKNOWN Catalan Stroke Code and Reperfusion Consortium (Cat-SCR)
Jan 23, 2020·Stroke; a Journal of Cerebral Circulation·Ludwig SchlemmChristian H Nolte
Jan 29, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Daniel A DworkisSanjay Arora
Jul 9, 2020·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·J Rodríguez-PardoB Fuentes
Mar 20, 2020·The Western Journal of Emergency Medicine·Benjamin J LawnerRahul Rahangdale
Jun 6, 2019·European Stroke Journal·Michael AllenKen Stein
Aug 21, 2021·Journal of Neurointerventional Surgery·Hayato ArakiTakeshi Morimoto

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