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Implementation of a Prehospital Stroke Triage System Using Symptom Severity and Teleconsultation in the Stockholm Stroke Triage Study

By Currents Editor posted 07-27-2020 09:56

  

JAMA Neurology (06/01/20) doi: 10.1001/jamaneurol.2020.0319
Mazya, Michael V.; Berglund, Annika; Ahmed, Niaz; et al
https://jamanetwork.com/journals/jamaneurology/article-abstract/2763539

A new prehospital stroke triage system resulted in much shorter delivery times for endovascular thrombectomy (EVT) without delaying intravenous thrombolysis (IVT), a recent study shows. The population-based prospective cohort study assessed the predictive performance of the Stockholm Stroke Triage System (SSTS) for large-artery occlusion (LAO) stroke and EVT initiation. The SSTS, which combines motor symptom severity and ambulance-to-hospital teleconsultation, was evaluated in 2,905 patients undergoing code-stroke ambulance transport in the Stockholm (Sweden) region from October 2017 to October 2018. Ambulance nurses tested patients’ degree of symptom severity with the face-arm-speech-time test. If moderate-to-severe hemiparesis was present, they would teleconsult with the comprehensive stroke center (CSC) physician for confirmation of suspected stroke, assessment of EVT eligibility, and direction to the CSC or nearest primary stroke center. The SSTS was 87% accurate for LAO stroke and 91% for EVT initiation. In addition, the 323 (11%) patients who had positive triage results had a median onset-to-puncture time of 137 minutes, compared with 206 in the previous year; had a median CSC IVT door-to-needle time was 13 minutes, compared with 31 minutes in the previous year; and the regional median onset-to-needle was unchanged, at 115 minutes.

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