European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for prehospital management of stroke
Eur. j. neurol
; 25(3): 425-433, March 2018.
Artigo
em Inglês
| BIGG - guias GRADE
| ID: biblio-988324
Biblioteca responsável:
BR1.1
ABSTRACT
Background and purpose The reduction of delay between onset and hospital arrival and adequate prehospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidencebased practices for the management of patients with suspected stroke in the prehospital setting. Methods The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations. Results Despite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a prehospital 'code stroke' including highest priority dispatch, prehospital notification and rapid transfer to the closest 'strokeready' centre. Insufficient evidence was found to recommend a prehospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for prehospital telemedicine during ambulance transport. Conclusions These guidelines inform on the contemporary approach to patients with suspected stroke in the prehospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome.
Texto completo:
Disponível
Coleções:
Bases de dados temática
Base de dados:
BIGG - guias GRADE
Assunto principal:
Acidente Vascular Cerebral
Tipo de estudo:
Ensaio clínico controlado
/
Guia de prática clínica
/
Estudo prognóstico
Idioma:
Inglês
Revista:
Eur. j. neurol
Ano de publicação:
2018
Tipo de documento:
Artigo
Instituição/País de afiliação:
Austrian Stroke Selfhelp Association/AT
/
Department of Neurology/GE
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Department of Neurology/NL
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Department of Neurology/NO
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Department of Neurology/PT
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Department of Neurology, Estonia Department of Neurology and Neurosurgery/EE
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Department of Neurosciences/ES
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Division of Medical Sciences/GB
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Institute of Neuroscience (Stroke Research Group)/GB
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Institute of Psychiatry and Neurology/PL