Comparing National Institutes of Health Stroke Scale Among a Stroke Team and Helicopter Emergency Medical Service Providers

Kesinger, Matthew R.; Sequeira, Denisse J; Buffalini, Samantha; Guyette, Francis X.

doi:10.1161/strokeaha.114.007850

Cited by 36 publications

(30 citation statements)

References 15 publications

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“…Where feasible, HEMS transport for transfer to an endovascular therapy-capable center is appropriate. HEMS personnel can administer on-scene NIHSS evaluation with moderate to good interrater reliability when compared with in-hospital stroke consultants [25]. Earlier activation and mobilization of the in-hospital stroke team may lead to faster treatment times.…”

Section: Prehospital Care Of Acute Strokementioning

confidence: 99%

Pre and intrahospital workflow for acute stroke treatment

Kircher

Kreitzer

Adeoye³

2016

Current Opinion in Neurology

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Purpose of review With the recent demonstration of the effectiveness of rapid recanalization of large vessel occlusions in acute ischemic stroke, it is important to assess the current status of pre and intrahospital workflow for acute stroke. Recent findings We will review trends in the evaluation and treatment of acute stroke and offer suggestions for how best to advance the workflow for acute stroke care in the coming years. Summary Future research is needed for: field use of clinical scores for predicting large vessel occlusions, telemedicine to facilitate prehospital triage, and pre and intrahospital processes for optimizing stroke care delivery.

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Section: Prehospital Care Of Acute Strokementioning

confidence: 99%

Pre and intrahospital workflow for acute stroke treatment

Kircher

Kreitzer

Adeoye³

2016

Current Opinion in Neurology

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“…In studies on the use of HEMS in stroke patients, Funder et al (2017) showed that the group they studied was dominated by men, and the median age was 69.8 (61.5-76.8) years [24]. Kesinger et al (2015) found that the use of HEMS in patients with stroke symptoms was dominated by women, and the median age was 70 (59-82) years. Timler et al (2015) also found that women dominated the use of HEMS in the therapeutic process of patients with stroke symptoms, and the average age of patients was 72 years [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Kesinger et al (2015) found that the use of HEMS in patients with stroke symptoms was dominated by women, and the median age was 70 (59-82) years. Timler et al (2015) also found that women dominated the use of HEMS in the therapeutic process of patients with stroke symptoms, and the average age of patients was 72 years [25,26]. The results of the present study showed that patients with suspected stroke were mainly women, and the average age was 72.75 years, which is in line with the results of Timler et al (2015) [26].…”

Section: Discussionmentioning

confidence: 99%

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study

Świeżewski

Rzońca²,

Pańczyk

et al. 2019

Med Sci Monit

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This research was co-financed as part of a competition for research projects and development projects aimed at the development of young scientists and Ph.D. students, financed as part of the scientific activities of WUM faculties-NZB/PM2/17/17 Background: A stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process. Material/Methods: A retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals. Results: Helicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients' condition was the drawing out of the extent of time spent by the crew at the scene. Conclusions: The use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

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“…Improving selection of patients eligible for EVT may have a major impact on stroke patients' outcome (2, 10). In the prehospital phase, the clinical variables (e.g., NIHSS and hemineglect) are theoretically available and the stroke severity assessment (NIHSS) by Emergency Medical Service personnel have an excellent interrater reliability (25). Still, adding these new variables to the NIHSS does not add clinically meaningful value, and we consider that NIHSS thresholds alone, if possible adapted to the timing and circulation (16), are sufficient to make decisions in most situations where immediate arterial imaging is not available.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Large Vessel Occlusions in Acute Stroke: National Institute of Health Stroke Scale Is Hard to Beat*

Vanacker

Heldner

Amiguet

et al. 2016

Critical Care Medicine

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1Objectives: Endovascular treatment for acute ischemic stroke with a large vessel occlusion was recently shown to be effective. We aimed to develop a score capable of predicting large vessel occlusion eligible for endovascular treatment in the early hospital management. Design: Retrospective, cohort study. Setting: Two tertiary, Swiss stroke centers. Patients: Consecutive acute ischemic stroke patients (1,645 patients; Acute STroke Registry and Analysis of Lausanne registry), who had CT angiography within 6 and 12 hours of symptom onset, were categorized according to the occlusion site. Demographic and clinical information was used in logistic regression analysis to derive predictors of large vessel occlusion (defined as intracranial carotid, basilar, and M1 segment of middle cerebral artery occlusions). Based on logistic regression coefficients, an integer score was created and validated internally and externally (848 patients; Bernese Stroke Registry). Interventions: None. Measurements and Main Results: Large vessel occlusions were present in 316 patients (21%) in the derivation and 566 (28%) in the external validation cohort. Five predictors added significantly to the score: National Institute of Health Stroke Scale at admission, hemineglect, female sex, atrial fibrillation, and no history of stroke and prestroke handicap (modified Rankin Scale score, < 2). Diagnostic accuracy in internal and external validation cohorts was excellent (area under the receiver operating characteristic curve, 0.84 both). The score performed slightly better than National Institute of Health Stroke Scale alone regarding prediction error (Wilcoxon signed rank test, p < 0.001) and regarding discriminatory power in derivation and pooled cohorts (area under the receiver operating characteristic curve, 0.81 vs 0.80; DeLong test, p = 0.02). Dr. Vanacker contributed to study concept and design, analysis, interpretation, and preparation of the article. Dr. Heldner contributed to data acquisition and analysis and critical revision of the article for important intellectual content. Dr. Amiguet contributed to data analysis and interpretation and preparation of the article. Dr. Faouzi contributed to data analysis. Dr. Cras contributed to critical revision of the article for important intellectual content. Dr. Ntaios contributed to the study concept and design, data analysis, and critical revision of the article for important intellectual content. Dr. Gralla contributed to data acquisition and analysis. Drs. Arnold and Mattle contributed to data analysis and critical revision of the article for important intellectual content. Dr. Fischer contributed to study concept and design, data acquisition and analysis, and critical revision of the article for important intellectual content. Dr. Michel contributed to study concept and design, data acquisition, analysis, and interpretation, and critical revision of the article for important intellectual content, study supervision.

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Comparing National Institutes of Health Stroke Scale Among a Stroke Team and Helicopter Emergency Medical Service Providers

Cited by 36 publications

References 15 publications

Pre and intrahospital workflow for acute stroke treatment

Pre and intrahospital workflow for acute stroke treatment

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study

Prediction of Large Vessel Occlusions in Acute Stroke: National Institute of Health Stroke Scale Is Hard to Beat*

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