Centrally Guided Identification of Patients With Large Vessel Occlusion: Lessons From Trauma Systems.
J Stroke Cerebrovasc Dis
; 28(9): 2388-2397, 2019 Sep.
Article
en En
| MEDLINE
| ID: mdl-31320270
ABSTRACT
OBJECTIVE:
Improve prehospital identification of acute ischemic stroke patients with large vessel occlusion (LVO) by using a trauma system-based emergency communication center (ECC) to guide the emergency medical service (EMS).METHODS:
We trained 24 ECC paramedics in the Emergency Medical Stroke Assessment (EMSA). ECC-guided EMS in performance of the EMSA on patients with suspected stroke. During the second half of the study, we provided focused feedback to ECC after reviewing recorded ECC-EMS interactions. We compared the sensitivity, specificity, and area under the receiver operator characteristics curve (AUC) and 95% confidence interval of ECC-guided EMSA to the NIH Stroke Scale (NIHSS) for predicting a discharge diagnosis of LVO.RESULTS:
We enrolled 569 patients from September 2016 through February 2018. Of 463 patients analyzed, 236 (51%) had a discharge diagnosis of stroke and 227 (49%) had a nonstroke diagnosis. There were 45 (19%) stroke patients with LVO. For predicting LVO, there was no significant difference between the EMSA AUCâ¯=â¯.68 (.59-.77) and the NIHSS AUCâ¯=â¯.73 (.65-.81). An EMSA score greater than or equal to 4 had sensitivityâ¯=â¯75.6 (60.5-87.1) and specificityâ¯=â¯62.4 (57.6-67.1) for LVO. During the first 9 months of the study, the EMSA AUCâ¯=â¯.61 (.44-.77) compared to an AUCâ¯=â¯.74 (.64-.84) during the second 9 months.CONCLUSIONS:
ECC-guided prehospital EMSA is feasible, has similar ability to predict LVO compared to the NIHSS, and has sustained performance over time.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Arteriopatías Oclusivas
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Isquemia Encefálica
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Competencia Clínica
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Accidente Cerebrovascular
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Sistemas de Comunicación entre Servicios de Urgencia
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Servicios Médicos de Urgencia
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Auxiliares de Urgencia
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Capacitación en Servicio
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Stroke Cerebrovasc Dis
Asunto de la revista:
ANGIOLOGIA
/
CEREBRO
Año:
2019
Tipo del documento:
Article