Shifting acute stroke management to the prehospital setting

Ebinger, Martin; Audebert, Heinrich J.

doi:10.1097/wco.0000000000001012

Cited by 5 publications

(4 citation statements)

References 61 publications

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“…Timely treatment is critical to the prognosis of stroke patients, which reduces mortality and improves neurological prognosis [21]. Efficient pre-hospital assessment is essential for EMS to differentiate between hemorrhagic and ischemic stroke [22]. Traditionally, ischemic and hemorrhagic stroke This study established a practical and convenient tool based on the FAST score and combined with age, systolic blood pressure, hypertension, and vomiting to predict the risk of hemorrhagic stroke in patients with suspected stroke symptoms for EMS staff.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Pan

et al. 2023

BMC Neurol

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Objectives The early detection and identification of stroke are essential to the prognosis of patients with suspected stroke symptoms out-of-hospital. We aimed to develop a risk prediction model based on the FAST score to identify the different types of strokes early for emergency medical services (EMS). Methods This retrospective observational study enrolled 394 stroke patients at a single center from January 2020 to December 2021. Demographic data, clinical characteristics, and stroke risk factors with patients were collected from the EMS record database. Univariate and multivariate logistic regression analysis was used to identify the independent risk predictors. The nomogram was developed based on the independent predictors, in which the discriminative value and calibration of the nomogram were verified by the receiver operator characteristic (ROC) curve and calibration plots. Results A total of 31.90% (88/276) of patients were diagnosed with hemorrhagic stroke in the training set, while 36.40% (43/118) in the validation set. The nomogram was developed based on the multivariate analysis, including age, systolic blood pressure, hypertension, vomiting, arm weakness, and slurred speech. The area under the curve (AUC) of the ROC with nomogram was 0.796 (95% CI: 0.740–0.852, P < 0.001) and 0.808 (95% CI:0.728–0.887, P < 0.001) in the training set and validation set, respectively. In addition, the AUC with the nomogram was superior to the FAST score in both two sets. The calibration curve showed a good agreement with the nomogram and the decision curves analysis also demonstrated that the nomogram had a wider range of threshold probabilities than the FAST score in the prediction risk of hemorrhagic stroke. Conclusions This novel noninvasive clinical nomogram shows a good performance in differentiating hemorrhagic and ischemic stroke for EMS staff prehospital. Moreover, all of the variables of nomogram are acquired in clinical practice easily and inexpensively out-of-hospital.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Pan

et al. 2023

BMC Neurol

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“…Timely treatment is critical to the prognosis of stroke patients, which reduces mortality and improves neurological prognosis [21]. E cient pre-hospital assessment is essential for EMS to differentiate between hemorrhagic and ischemic stroke [22]. Traditionally, ischemic and hemorrhagic stroke had the common risk factors.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Pan

et al. 2022

Preprint

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Objectives: The early detection and identification of stroke are essential to the prognosis of patients with suspected stroke symptoms out-of-hospital. We aimed to develop a risk prediction model based on the FAST score to identify the different types of strokes early for emergency medical services (EMS). Methods: This retrospective observational study enrolled 394 stroke patients at a single center from January 2020 to December 2021. Demographic data, clinical characteristics, and stroke risk factors with patients were collected from the EMS record database. Univariate and multivariate logistic regression analysis was used to identify the independent risk predictors. The nomogram was developed based on the independent predictors, in which the discriminative value and calibration of the nomogram were verified by the receiver operator characteristic (ROC) curve and calibration plots. Results: A total of 31.90% (88/276) of patients were diagnosed with hemorrhagic stroke in the training set, while 36.40% (43/118) in the validation set. The nomogram was developed based on the multivariate analysis, including age, systolic blood pressure, hypertension, vomiting, arm weakness, and slurred speech. The area under the curve (AUC) of the ROC with nomogram was 0.796 (95% CI: 0.740-0.852,P<0.001) and 0.808 (95% CI:0.728-0.887, P<0.001) in the training set and validation set, respectively. In addition, the AUC with the nomogram was superior to the FAST score in both two sets. The calibration curve showed a good agreement with the nomogram and the decision curves analysis also demonstrated that the nomogram had a wider range of threshold probabilities than the FAST score in the prediction risk of hemorrhagic stroke. Conclusions: This novel noninvasive clinical nomogram shows a good performance in differentiating hemorrhagic and ischemic stroke for EMS staff prehospital. Moreover, all of the variables of nomogram are acquired in clinical practice easily and inexpensively out-of-hospital.

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“…Two recent studies, a non-RCT and an RCT, reported that in patients with acute stroke who were eligible for rtPA, global disability at 3 months was lower with MSU compared to in-person professional stroke care [144, 145]. As well, a recent review reported that MSU resulted in shorter onset-to-treatment times in mostly urban settings [146].…”

Section: Telemedicine and Mobile Stroke Unitsmentioning

confidence: 99%

Treatments in Ischemic Stroke: Current and Future

Mosconi¹,

Paciaroni²

2022

Eur Neurol

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Background and Aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of drugs with better safety-efficacy profiles as well as strategies able to improve ischemic stroke management from the pre-hospital setting is needed. Summary: The pathophysiology of ischemic stroke involves multiple pathways resulting in cerebral artery obstruction and brain tissue ischemia. To date, the only approved drug for acute ischemic stroke is intravenous thrombolytic alteplase. Intravenous thrombolysis (IVT) can be administered alone or in combination with endovascular treatment (EVT) with mechanical thrombectomy, in case of large vessel occlusion and generally within 6 h from symptoms onset. The risk of potential bleeding complications, especially symptomatic intracerebral hemorrhage, is one of the reasons for the reluctance to administer IVT. Tenecteplase is a promising alternative fibrinolytic agent, having a better safety profile than alteplase. Moreover, recent evidences have allowed an extension of the IVT ± EVT time window for patients with unknown onset time and for those with a known onset time thanks to the new “tissue-window” approach guided by advanced neuroimaging techniques, which also helps in collateral circulation estimation. Regarding primary-secondary prevention, researchers are focused on improving the efficacy of antithrombotic drugs with a “hemostasis-sparing” approach. Neuroprotective agents are also under development, particularly stem cells. The COVID-19 pandemic has critically stressed global healthcare systems, with collateral damage resulting in access delivery of only emergency care, such as ischemic stroke. Regarding telemedicine, it has had a minor role in acute stroke management, and with the onset of COVID-19, this role will most likely be adopted to increase access and delivery in stroke assessment, but also in the follow-up.

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Shifting acute stroke management to the prehospital setting

Cited by 5 publications

References 61 publications

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Treatments in Ischemic Stroke: Current and Future

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