Prehospital Comprehensive Stroke Center vs Primary Stroke Center Triage in Patients With Suspected Large Vessel Occlusion Stroke

Kass‐Hout, Tareq; Lee, Jung Hwa; Tataris, Katie; Richards, Christopher T; Markul, Eddie; Weber, Joseph; Mendelson, Scott; O’Neill, Kathleen; Sednew, Renee

doi:10.1001/jamaneurol.2021.2485

Cited by 27 publications

(16 citation statements)

References 48 publications

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“…Recently, implementation of a prehospital triage program for patients with suspected large vessel occlusions directly to appropriate endovascular-capable stroke centers significantly improved rates of endovascular therapy, which is known to improve functional outcomes. 40 Similarly, the use of mobile stroke units, even in smaller urban areas have shown to be effective in reducing door-to-needle time compared with traditional emergency transport. 41 , 42 High-risk patients, patients with DE, and minority patients should be intentionally targeted by such programs.…”

Section: Discussionmentioning

confidence: 99%

Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity

et al. 2022

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Key Points Question Are dual eligibility for Medicare and Medicaid, a proxy for low socioeconomic status, and race and ethnicity associated with stroke severity? Findings In this cross-sectional study of 45 459 Medicare fee-for-service patients with ischemic stroke, Black, Hispanic, and dually eligible patients, including White patients with dual eligibility, had significantly increased likelihood of having a severe stroke. Meaning Based on these findings, it is important that dual-eligible patients, Black patients, and Hispanic patients receive access to timely and high-quality stroke care to improve stroke recovery and long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity

et al. 2022

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“…This has led to reorganization in subspecialties within the clinical‐academic environment. To name a few: stroke centers have been established [1] to improve access to recanalization therapy; movement disorder clinics [2] and epilepsy units [3] now liaise with neurosurgery to offer surgical options on top of other medical approaches; and neuromuscular centers [4] offer multidisciplinary care including gene therapy. While this subspecialization is useful for the development of specific competences and for research, it presents the risk of silos and fragmentation [5] in the sense that each subspecialty works independently without a more comprehensive view of the condition of the individual patient.…”

Section: Introductionmentioning

confidence: 99%

The borderland of multiple sclerosis and functional neurological disorder: A call for clinical research and vigilance

Aybek

Chan

2022

Euro J of Neurology

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Background and purpose Functional neurological disorders (FNDs) have attracted much attention from the neurological medical community over the last decades as new developments in neurosciences have reduced stigma around these by showing brain network dysfunctions. An overlap with other neurological conditions such as multiple sclerosis (MS) is well known by clinicians but there is a lack of clinical and fundamental research in this field to better define diagnosis and therapeutic decisions, as well as a lack of deep understanding of the underlying pathophysiology. Aim We aimed to provide a critical commentary on the state of knowledge about the borderland between FNDs and MS. Methods We based our commentary on a joint point of view between an FND specialist and an MS expert. Results A brief review of the previous literature and relevant new studies covering the overlap between FNDs and MS is presented, along with suggestions for future research directions. Conclusion There are clear diagnostic criteria for both FNDs and MS and a strict application of these will help better diagnosis and prevent unnecessary treatment escalation in MS or absence of referral to multimodal therapy in FND. Better teaching of younger neurologists is needed as well as prospective research focusing on pathophysiology.

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“…In many geographic regions, the additional transport time to the EVT center may be less than 30 min, and the most recent American Heart Association (AHA) guidelines suggest direct transfer to CSCs for patients within 30 min of CSC in urban regions, 45 min for suburban, and 60 min for rural areas 8. In previous studies across a variety of geographic regions, direct field triage has been shown to increase rates of EVT9 and reduce time to treatment, but those studies were conducted over an approximately 2 year time span 10–12. The impact of triage on time to treatment over a longer time span is unknown.…”

Section: Introductionmentioning

confidence: 99%

Long-term effect of field triage on times to endovascular treatment for emergent large vessel occlusion

Jayaraman

Baird

Ouediat

et al. 2022

J NeuroIntervent Surg

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BackgroundDelays to endovascular therapy (EVT) for stroke may be mitigated with direct field triage to EVT centers. We sought to compare times to treatment over a 5.5 year span between two adjacent states, one with field triage and one without, served by a single comprehensive stroke center (CSC).MethodsDuring the study period, one of the two states implemented severity-based triage for suspected emergent large vessel occlusion, while in the other state, patients were transported to the closest hospital regardless of severity. We compared times to treatment and clinical outcomes between these two states. We also performed a matched pairs analysis, matching on date treated and distance from field to CSC.Results639 patients met the inclusion criteria, 407 in State 1 (with field triage) and 232 in State 2 (without field triage). In State 1, scene to EVT decreased 6% (or 8.13 min, p=0.0004) every year but no decrease was observed for State 2 (<1%, p=0.94). Cumulatively over 5.5 years, there was a reduction of 43 min in time to EVT in State 1, but no change in State 2. Lower rates of disability were seen in State 1, both for the entire cohort (all OR 1.22, 95% CI 1.07 to 1.40, p=0.0032) and for those independent at baseline (1.36, 95% CI 1.15 to 1.59, p=0.0003).ConclusionsComparing adjacent states over time, the implementation of severity-based field triage significantly reduced time to EVT.

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Prehospital Comprehensive Stroke Center vs Primary Stroke Center Triage in Patients With Suspected Large Vessel Occlusion Stroke

Cited by 27 publications

References 48 publications

Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity

Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity

The borderland of multiple sclerosis and functional neurological disorder: A call for clinical research and vigilance

Long-term effect of field triage on times to endovascular treatment for emergent large vessel occlusion

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