A Mobile Stroke Treatment Unit for Field Triage of Patients for Intraarterial Revascularization Therapy

Cerejo, Russell; John, Seby; Buletko, Andrew Blake; Taqui, Ather; Itrat, Ahmed; Organek, Natalie; Cho, Sung Min; Sheikhi, Lila; Uchino, Ken; Briggs, Farren; Reimer, Andrew P.; Winners, Stacey; Tóth, Gábor; Rasmussen, Peter A.; Hussain, Muhammad Shazam

doi:10.1111/jon.12276

Cited by 64 publications

(57 citation statements)

References 31 publications

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“…FNR represents the proportion of patients who would not have been sent to a CSC despite LAO, hence delaying optimal treatment, and FPR represents the proportion of patients who would have been sent to a CSC despite lack of LAO (futile transfers). The highest accuracy (79%; 95% confidence interval, 77-82) was observed for NIHSS score ≥11 (FNR, 27% [22][23][24][25][26][27][28][29][30][31][32]; FPR, 17% [14][15][16][17][18][19][20]), NIHSS score ≥14 (FNR, 39% [34][35][36][37][38][39][40][41][42][43][44]; FPR, 12% [9][10][11][12][13][14]), and RACE score ≥5 (FNR, 33% [28][29][30][31][32][33][34][35][36][37][38]; FPR, 15% [12][13][14]…”

Section: Resultsmentioning

confidence: 96%

“…Prehospital brain and arterial imaging using a mobile stroke unit might be an interesting option for patient triage in selected areas, but it remains to be demonstrated whether this expensive management approach is costeffective in the era of bridging therapy. [25][26][27] Other promising strategies that could help prehospital identification of stroke patients with LAO include serum biomarkers aiming to differentiate AIS and intracerebral hemorrhage 28,29 and automated or telemedicine-guided transcranial ultrasound imaging. 30,31 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Turc

Maïer

Naggara

et al. 2016

Stroke

162

138

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Background and Purpose-It remains debated whether clinical scores can help identify acute ischemic stroke patients with large-artery occlusion and hence improve triage in the era of thrombectomy. We aimed to determine the accuracy of published clinical scores to predict large-artery occlusion. Methods-We assessed the performance of 13 clinical scores to predict large-artery occlusion in consecutive patients with acute ischemic stroke undergoing clinical examination and magnetic resonance or computed tomographic angiography ≤6 hours of symptom onset. When no cutoff was published, we used the cutoff maximizing the sum of sensitivity and specificity in our cohort. We also determined, for each score, the cutoff associated with a false-negative rate ≤10%. Results-Of 1004 patients (median National Institute of Health Stroke Scale score, 7; range, 0-40), 328 (32.7%) had an occlusion of the internal carotid artery, M1 segment of the middle cerebral artery, or basilar artery. The highest accuracy (79%; 95% confidence interval, 77-82) was observed for National Institute of Health Stroke Scale score ≥11 and Rapid Arterial Occlusion Evaluation Scale score ≥5. However, these cutoffs were associated with false-negative rates >25%. Cutoffs associated with an false-negative rate ≤10% were 5, 1, and 0 for National Institute of Health Stroke Scale, Rapid Arterial Occlusion Evaluation Scale, and Cincinnati Prehospital Stroke Severity Scale, respectively. Conclusions-Using published cutoffs for triage would result in a loss of opportunity for ≥20% of patients with large-artery occlusion who would be inappropriately sent to a center lacking neurointerventional facilities. Conversely, using cutoffs reducing the false-negative rate to 10% would result in sending almost every patient to a comprehensive stroke center. Our findings, therefore, suggest that intracranial arterial imaging should be performed in all patients with acute ischemic stroke presenting within 6 hours of symptom onset.

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Turc

Maïer

Naggara

et al. 2016

Stroke

162

138

View full text Add to dashboard Cite

show abstract

“…Currently, programs for prehospital stroke treatment are in operation at several stroke centers [7,8,9,10,11,12,13,14]. Reports from these programs confirm the enormous time gain associated with prehospital stroke treatment and show that treatment rates can be significantly increased [9].…”

Section: Introductionmentioning

confidence: 86%

First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

et al. 2016

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Background: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). Methods: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. Results: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. Conclusions: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital.

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“…11 Most recently the Cleveland MSU group was able to demonstrate this concept and the effectiveness in the MSU in the rapid triage of patients with Acute Ischemic Stroke (AIS) from large vessel occlusions to a facility with interventional capabilities thereby saving precious time spent in inter hospital transfers. 12 In their study they were able to show that the time from door to groin puncture, and the first picture to groin puncture was shorter by almost one-half in the Mobile stroke treatment units (MSTUs) group when compared to Emergency Medical Systems (EMS)/private transport. Moreover, the MSU could allow for organization of further specialized treatments and etiology-specific blood pressure management already in the pre-hospital phase of stroke management.…”

Section: This Strategy Was First Proposed In Germany In 2003mentioning

confidence: 99%

Mobile Stroke Unit (MSU): The Future of Acute Stroke Treatment?

Guerrero

2016

Neuro Open J

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A Mobile Stroke Treatment Unit for Field Triage of Patients for Intraarterial Revascularization Therapy

Abstract: Our initial experience shows that MSTU may help in early triage and shorten the time to IAT for AIS.

Cited by 64 publications

References 31 publications

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

Mobile Stroke Unit (MSU): The Future of Acute Stroke Treatment?

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