Technological innovation for prehospital stroke triage: ripe for disruption

Martínez-Gutiérrez, Juan Carlos; Chandra, Ronil V.; Hirsch, Joshua A; Leslie‐Mazwi, Thabele M

doi:10.1136/neurintsurg-2019-014902

Cited by 19 publications

(15 citation statements)

References 51 publications

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“…In our study the proportion of overtriage significantly declined after the training course. To improve the accuracy of prehospital stroke triage further, some technological innovations such as artificial intelligence may help prehospital personnel to make a correct triage 34. It is reported that more than 10 000 mechanical thrombectomy procedures are performed in the USA every year,35 36 and the procedures are performed most often during non-work hours 37.…”

Section: Discussionmentioning

confidence: 99%

Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

Chiu

Tang

Sun

et al. 2019

J NeuroIntervent Surg

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IntroductionThe shorter the time between the onset of symptoms and reperfusion using endovascular thrombectomy, the better the functional outcome of patients. A training program was designed for emergency medical technicians (EMTs) to learn the gaze-face-arm-speech-time test (G-FAST) score for initiating a prehospital bypass strategy in an urban city. This study aimed to evaluate the effect of the training program on EMTs.MethodsAll EMTs in the city were invited to join the training program. The program consisted of a 30 min lecture and a 20 min video which demonstrated the G-FAST evaluation. The participants underwent tests before and after the program. The tests included (1) a questionnaire of knowledge, attitudes, confidence, and behaviors towards stroke care; and (2) watching 10 different scenarios in a video and answering questions, including eight sub-questions of G-FAST parameters, and choosing a suitable receiving hospital.ResultsIn total, 1058 EMTs completed the training program. After the program, significant improvement was noted in knowledge, attitudes, and confidence, as well as scenario judgement. The performance of the EMTs in evaluating G-FAST criteria in comatose patients was relatively poor in the pre-test and improved significantly after the training course. Although the participants answered the G-FAST items correctly, they tended to overtriage the patients and refer them to higher-level hospitals.ConclusionsA short training program can improve the ability to identify stroke patients and choose a suitable receiving hospital. A future training program could put further emphasis on how to evaluate comatose patients and choose a suitable receiving hospital.

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Section: Discussionmentioning

confidence: 99%

Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

Chiu

Tang

Sun

et al. 2019

J NeuroIntervent Surg

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“…Several apps that have been designed to aid EMS specifically with pre-hospital stroke severity assessment and risk stratification can help to facilitate this task. 15…”

Section: Clinical Stroke Severity Scalesmentioning

confidence: 99%

“…Perhaps even more important than the performance of a particular stroke scale itself is the need for the local EMS personnel to be familiar with it and comfortable using it. Several apps that have been designed to aid EMS specifically with pre-hospital stroke severity assessment and risk stratification can help to facilitate this task 15…”

Section: Pre-hospital Triage: Detecting Evt Candidates In the Fieldmentioning

confidence: 99%

Recent developments in pre-hospital and in-hospital triage for endovascular stroke treatment

Ospel

Dmytriw

Regenhardt

et al. 2022

J NeuroIntervent Surg

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Triage describes the assignment of resources based on where they can be best used, are most needed, or are most likely to achieve success. Triage is of particular importance in time-critical conditions such as acute ischemic stroke. In this setting, one of the goals of triage is to minimize the delay to endovascular thrombectomy (EVT), without delaying intravenous thrombolysis or other time-critical treatments including patients who cannot benefit from EVT. EVT triage is highly context-specific, and depends on availability of financial resources, staff resources, local infrastructure, and geography. Furthermore, the EVT triage landscape is constantly changing, as EVT indications evolve and new neuroimaging methods, EVT technologies, and adjunctive medical treatments are developed and refined. This review provides an overview of recent developments in EVT triage at both the pre-hospital and in-hospital stages. We discuss pre-hospital large vessel occlusion detection tools, transport paradigms, in-hospital workflows, acute stroke neuroimaging protocols, and angiography suite workflows. The most important factor in EVT triage, however, is teamwork. Irrespective of any new technology, EVT triage will only reach optimal performance if all team members, including paramedics, nurses, technologists, emergency physicians, neurologists, radiologists, neurosurgeons, and anesthesiologists, are involved and engaged. Thus, building sustainable relationships through continuous efforts and hands-on training forms an integral part in ensuring rapid and efficient EVT triage.

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“…38,39 With MT now established as standard of care in AIS due to LVO, efforts are focused on organized workflow in the field, timely triage, and post-arrival care at comprehensive stroke centersto help expedite treatment and improve patient outcomes. 40,41…”

Section: Current Guidelines For Mechanical Thrombectomymentioning

confidence: 99%

“…However, guidelines from organizations such as the AHA/ASA have not changed at this time due to lack of higher level of scientific evidence, and thus operator experience and judgement play a large role in determination of appropriateness 38,39 . With MT now established as standard of care in AIS due to LVO, efforts are focused on organized workflow in the field, timely triage, and post‐arrival care at comprehensive stroke centers—to help expedite treatment and improve patient outcomes 40,41 …”

Section: Introductionmentioning

confidence: 99%

Patient and procedure selection for mechanical thrombectomy: Toward personalized medicine and the role of artificial intelligence

Saiegh

Múñoz

Velagapudi

et al. 2022

Journal of Neuroimaging

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Mechanical thrombectomy (MT) for ischemic stroke due to large vessel occlusion is standard of care. Evidence-based guidelines on eligibility for MT have been outlined and evidence to extend the treatment benefit to more patients, particularly those at the extreme ends of a stroke clinical severity spectrum, is currently awaited. As patient selection continues to be explored, there is growing focus on procedure selection including the tools and techniques of thrombectomy and associated outcomes. Artificial intelligence (AI) has been instrumental in the area of patient selection for MT with a role in diagnosis and delivery of acute stroke care. Machine learning algorithms have been developed to detect cerebral ischemia and early infarct core, presence of large vessel occlusion, and perfusion deficit in acute ischemic stroke. Several available deep learning AI applications provide ready visualization and interpretation of cervical and cerebral arteries. Further enhancement of AI techniques to potentially include automated vessel probe tools in suspected large vessel occlusions is proposed. Value of AI may be extended to assist in procedure selection including both the tools and technique of thrombectomy. Delivering personalized medicine is the wave of the future and tailoring the MT treatment to a stroke patient is in line with this trend. K E Y W O R D Sartificial intelligence, mechanical thrombectomy, stroke significantly improved patient selection and delivery of acute stroke care. 12,13 In recent years, there has been a marked improvement in thrombectomy device technology and refinements in procedure techniques. In times of growing scientific interest and shifting focus on 798

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Technological innovation for prehospital stroke triage: ripe for disruption

Cited by 19 publications

References 51 publications

Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy

Recent developments in pre-hospital and in-hospital triage for endovascular stroke treatment

Patient and procedure selection for mechanical thrombectomy: Toward personalized medicine and the role of artificial intelligence

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