Accuracy and Implications of Hemorrhagic Stroke Recognition by Emergency Medical Services

Oostema, John A; Chassee, Todd; Baer, William; Edberg, Allison; Reeves, Mathew J.

doi:10.1080/10903127.2020.1831669

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…In patients with sudden onset of neurological symptoms or signs attributable to potential spontaneous ICH, use of stroke recognition and severity tools is recommended for dispatch personnel and first responders to identify potential stroke and facilitate rapid transport to reduce time to diagnosis and treatment. [36][37][38][39][40][41] 1 B-NR 3. In patients with stroke symptoms attributable to potential spontaneous ICH, immediate activation of the emergency response system (9-1-1 in North America) is recommended to reduce time to diagnosis and treatment. 32,42 1 B-NR 4. In patients with potential spontaneous ICH, early notification by emergency medical services (EMS) staff to the receiving hospital is recommended to improve time to diagnosis and treatment.…”

Section: B-rmentioning

confidence: 99%

“…For dispatch, a group found that a specific dispatch stroke assessment tool was associated with shorter time to diagnosis, 37 and a clinical trial found that a dispatch stroke screen reduced time to both hospital arrival and stroke unit admission (although only 5% had ICH). 36 One group analyzed ICH specifically 39 and found an association between documented stroke scale use and ICH recognition. The sensitivity for ICH was 84%, and stroke scale documentation was independently associated with ICH recognition and shorter door–to–computed tomography (CT) times (20 minutes versus 47 minutes).…”

Section: Organization Of Prehospital and Initial Systems Of Carementioning

confidence: 99%

See 1 more Smart Citation

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Greenberg¹,

Ziai²,

Cordonnier³

et al. 2022

Stroke

690

472

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other entities (RWI) can be found at https://professional. heart.org/-/media/phd-files/guidelines-and-statements/ policies-devolopment/aha-asa-disclosure-rwi-policy-5118. pdf?la=en.Beginning in 2017, numerous modifications to AHA/ ASA guidelines have been implemented to make guidelines shorter and enhance user-friendliness. Guidelines are written and presented in a modular knowledge chunk format; each chunk includes a table of recommendations, a brief synopsis, recommendation-specific supportive text, and, when appropriate, flow diagrams or additional tables. Hyperlinked references are provided to facilitate quick access and review. Other modifications to the guidelines include the addition of Knowledge Gaps and Future Research segments in some sections and a web guideline supplement (Online Data Supplement) for useful but noncritical tables and figures.

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Section: B-rmentioning

confidence: 99%

Section: Organization Of Prehospital and Initial Systems Of Carementioning

confidence: 99%

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Greenberg¹,

Ziai²,

Cordonnier³

et al. 2022

Stroke

690

472

View full text Add to dashboard Cite

show abstract

“…Similarly, Kleindorfer et al 25 showed that among patients with ICH or subarachnoid hemorrhage, 69% are FAST positive, compared with 91% for ischemic stroke. According to Oostema et al , 26 65% of ICH patients were recognized by ambulance staff when mainly using the Cincinnati Prehospital Stroke Scale. Compared with other prehospital scales aimed at recognizing LVO stroke, the SSTS provides a higher specificity and a lower sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Impact of prehospital stroke triage implementation on patients with intracerebral hemorrhage

Almqvist

Delgado

Sjöstrand

et al. 2023

Ther Adv Neurol Disord

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Background: Little is known about how prehospital triage using large vessel occlusion (LVO) stroke prediction scales affects patients with intracerebral hemorrhage (ICH). Objectives: We aimed to investigate whether the Stockholm Stroke Triage System (SSTS) implemented in 2017 has affected timing and outcomes of acute ICH neurosurgery, and to assess system triage accuracy for ICH with a neurosurgical indication or LVO thrombectomy. Design: Observational cohort study. Methods: In the Stockholm Region, we compared surgical timing, functional outcome, and death at 3 months in patients transported by code-stroke ground ambulance who had ICH neurosurgery, 2 years before versus 2 years after SSTS implementation. We also calculated triage precision metrics for treatment with either ICH neurosurgery or thrombectomy. Results: A total of 36 patients undergoing ICH neurosurgery were included before SSTS implementation and 30 after. No significant difference was found in timing of neurosurgery [median 7.5 (4.9–20.7) versus 9.1 (6.1–12.5) h after onset], distribution of functional outcomes (median 4 versus 4), and death at 3 months [3/29 (9%) versus 5/35 (17%)] before versus after implementation, respectively. The SSTS routed a larger proportion of patients subsequently undergoing ICH neurosurgery directly to the comprehensive stroke center: 13/36 (36%) before versus 18/30 (60%) after implementation. Overall system triage accuracy for ICH neurosurgery or thrombectomy was high at 90%, with 92% specificity and 65% sensitivity. Conclusion: The SSTS, initially designed for prehospital LVO stroke triage, routed more patients with neurosurgical indication for ICH directly to the comprehensive stroke center. This did not significantly affect surgical timing or outcomes.

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“…4 Therefore, early triage and transportation of patients with suspected stroke to the appropriate hospitals are crucial for acute LVO and the other types of stroke. 5 We devised and reported two prehospital stroke triage scales-namely, the Japan Urgent Stroke Triage (JUST) score and seven-item Japan Urgent Stroke Triage (JUST-7) score, which can simultaneously distinguish between LVO, ICH, SAH, and cerebral infarction other than LVO (CI). 6 7 In Japan, the JUST score is currently used by many EMS at the point of patient contact to determine the appropriate hospital for the treatment of the stroke.…”

Section: Introductionmentioning

confidence: 99%

Effect of region-wide use of prehospital stroke triage scale on management of patients with acute stroke

Araki

Uchida

Kurisu

et al. 2021

J NeuroIntervent Surg

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BackgroundPrehospital stroke triage scales help with the decision to transport patients with suspected stroke to suitable hospitals.ObjectiveTo explore the effect of the region-wide use of the Japan Urgent Stroke Triage (JUST) score, which can predict several types of stroke: large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction other than LVO (CI).MethodsWe implemented the JUST score and conducted a retrospective and prospective multicenter cohort study at 13 centers in Hiroshima from April 1, 2018, to March 31, 2020. We investigated the success rate of the first request to the hospital, on-scene time, and transport time to hospital. We evaluated the door-to-puncture time, puncture-to-reperfusion time, and 90-day outcome among patients with final diagnoses of LVO.ResultsThe cohort included 5141 patients (2735 before and 2406 after JUST score implementation). Before JUST score implementation, 1269 strokes (46.4%) occurred, including 140 LVO (5.1%), 394 ICH (14.4%), 120 SAH (4.4%), and 615 CI (22.5%). The JUST score was used in 1484 (61.7%) of the 2406 patients after implementation, which included 1267 (52.7%) cases of stroke (186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%), and 567 CI (23.6%)). Success rate of the first request to the hospital significantly increased after JUST score implementation (76.3% vs 79.7%, p=0.004). JUST score implementation significantly shortened the door-to-puncture time (84 vs 73 min, p=0.03), but the prognosis remained unaltered among patients with acute LVO.ConclusionsUse of prehospital stroke triage scales improved prehospital management and preparation time of intervention among patients with acute stroke.

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Accuracy and Implications of Hemorrhagic Stroke Recognition by Emergency Medical Services

Cited by 10 publications

References 21 publications

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Impact of prehospital stroke triage implementation on patients with intracerebral hemorrhage

Effect of region-wide use of prehospital stroke triage scale on management of patients with acute stroke

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