Diagnostic value of prehospital ECG in acute stroke patients

Bobinger, Tobias; Kallmünzer, Bernd; Kopp, Markus; Kurka, Natalia; Arnold, Martin; Heider, Stefan; Schwab, Stefan; Köhrmann, Martin

doi:10.1212/wnl.0000000000003940

Cited by 12 publications

(8 citation statements)

References 24 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Detection and treatment of atrial fibrillation by ECG is a major goal in secondary stroke prevention, and guidelines suggest that an ECG should be performed within 45 min. 19 In our study, although the rate of ECG use in the high-HPCP group hospitals was higher than the low-HPCP group hospitals, the use of ECG in both groups of hospitals showed a downward trend in recent years, which is an unsettling trend. International Journal of Stroke, 18 (3) Functional assessment plays a crucial role in subsequent correct treatment decisions and patient outcomes.…”

Section: Discussioncontrasting

confidence: 57%

The quality disparity of stroke care over time: An analysis based on the national dataset from 2011 to 2017

Chen

Wang

et al. 2022

International Journal of Stroke

View full text Add to dashboard Cite

Background: Hospital adherence to evidence-based stroke care is variable and changes over time. We take full account of these variations and determined indicators which could reduce adverse outcomes and narrow inter-hospital variation in stroke patients under the current protocol of clinical treatment for stroke. Methods: We analyzed data from 123259 patients diagnosed with acute ischemic stroke (AIS) who were treated at 109 large tertiary hospitals from January 2011 to May 2017. Hospitals were divided into subgroups according to the time trend of hospital process composite performance (HPCP, that were calculated by the method of opportunity-based score on patient-level) estimated by the Group Based Model. We analyzed the influence of hospital subgroups on the patient outcomes using a multi-level model and explored the quality indicators (QIs) that led to variation. Results: The HPCP trends for stroke indicators of 109 hospitals over 7 years were divided into two groups (Group 1, low-HPCP; Group 2, high-HPCP). Patients in Group 2 tended to have a higher rate of independence (modified Rankin Scale≤2). The multi-level model showed that there was a statistically significant difference in the utilization rate between the two groups, which mainly focused on the emergency examination and function evaluation indicators. Conclusions: Variation in the quality of stroke care exists across hospitals. We found that QIs related to emergency examination and functional assessment were the main factors in different trends of stroke HPCP over time and identifying hospital care differences, suggesting that quality improvement in stroke care could prioritize these QIs.

show abstract

Section: Discussioncontrasting

confidence: 57%

The quality disparity of stroke care over time: An analysis based on the national dataset from 2011 to 2017

Chen

Wang

et al. 2022

International Journal of Stroke

View full text Add to dashboard Cite

show abstract

“…However, in 11% of these the atrial fibrillation was no longer present in-hospital. The authors therefore argue, that pre-hospital ECG recording is important, despite of the extra time spent on-scene [24].…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital management of acute stroke patients eligible for thrombolysis – an evaluation of ambulance on-scene time

Drenck

Viereck

Baekgaard

et al. 2019

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

BackgroundStroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component. We aimed to analyse ambulance OST in stroke patients eligible for thrombolysis and identify potential areas of time optimization.MethodsA study-specific registration form was developed to record detailed information about OST consumption in cases where the Emergency Medical Services (EMS) suspected a stroke from July 2014–May 2015. Registration forms were completed by ambulance personnel and included details on estimated time spent: 1) localising patient, 2) clinical examination, 3) consulting with the on-call neurologist, 4) mobilising patient to the ambulance, 5) treatment in ambulance before departure. Additionally, estimated total OST was noted. For patients found eligible for further evaluation at a stroke centre, time points were analysed using multivariate Poisson regressions.ResultsA total of 520 cases were included. The median OST was 21 min (Interquartile Range (IQR) 16–27). Time consumption was significantly lower (17 vs 21 min, p = 0.0015) when electrocardiography (ECG) was obtained in-hospital instead of on-scene, when intravenous (IV) access was established during transportation instead of before transportation (17 vs 21 min, p < 0.0001), and when the quality of communication with the stroke centres was rated as “good” as opposed to “acceptable/poor” (21 vs 23 min, p = 0.014). Neither the presence of relatives nor ambulance trainees had a significant effect on OST.ConclusionsIn-hospital ECG recording and IV cannulation during transport were found to reduce OST, while “acceptable/poor” communication was found to prolong OST relative to “good” communication. These components of pre-hospital stroke management represent potential opportunities for lowering OST with relatively simple changes, which could ultimately lead to earlier treatment and better patient outcome.Trial registrationUnique identifier: NCT02191514.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0580-4) contains supplementary material, which is available to authorized users.

show abstract

“…Although medical history may not always be available, the electrocardiogram and blood pressure displayed on the monitor during transfer can provide some insight. 10 , 11 Because data-sharing technologies between hospitals is rapidly developing in China, 12 , 13 data-sharing technology could soon include the prehospital stage, which would be helpful for application of the SHIPS scale in the future.…”

Section: Discussionmentioning

confidence: 99%

Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion

Shao

Zhang

Jin

et al. 2022

Ther Adv Neurol Disord

View full text Add to dashboard Cite

Background: Rapid recognition of acute stroke and large vessel occlusion (LVO) is essential in prehospital triage for timely reperfusion treatment. Objective: This study aimed to develop and validate a new screening tool for both stroke and LVO in an urban Chinese population. Methods: This study included patients with suspected stroke who were transferred to our hospital by emergency medical services between July 2017 and June 2021. The population was randomly partitioned into training (70%) and validation (30%) groups. The Staring-Hypertension-atrIal fibrillation-sPeech-weakneSs (SHIPS) scale, consisting of both clinical and medical history information, was generated based on multivariate logistic models. The predictive ability of the SHIPS scale was evaluated and compared with other scales using receiver operating characteristic (ROC) curve comparison analysis. Results: A total of 400 patients were included in this analysis. In the training group ( n = 280), the SHIPS scale showed a sensitivity of 90.4% and specificity of 60.8% in predicting stroke and a sensitivity of 75% and specificity of 61.5% in predicting LVO. In the validation group ( n = 120), the SHIPS scale was not inferior to Stroke 1-2-0 ( p = 0.301) in predicting stroke and was significantly better than the Cincinnati Stroke Triage Assessment Tool (C-STAT; formerly CPSSS) and the Prehospital Acute Stroke Severity scale (PASS) (all p < 0.05) in predicting LVO. In addition, including medical history in the scale was significantly better than using symptoms alone in detecting stroke (training group, 0.853 versus 0.818; validation group, 0.814 versus 0.764) and LVO (training group, 0.748 versus 0.722; validation group, 0.825 versus 0.778). Conclusion: The SHIPS scale may serve as a superior screening tool for stroke and LVO identification in prehospital triage. Including medical history in the SHIPS scale improves the predictive value compared with clinical symptoms alone.

show abstract

Diagnostic value of prehospital ECG in acute stroke patients

Abstract: In a selected cohort of patients with stroke, the in-field recordings of the ECG detected a relevant rate of cardiac arrhythmia. The results can add to the in-hospital evaluation and should be considered in prehospital care of acute stroke.

Cited by 12 publications

References 24 publications

The quality disparity of stroke care over time: An analysis based on the national dataset from 2011 to 2017

The quality disparity of stroke care over time: An analysis based on the national dataset from 2011 to 2017

Pre-hospital management of acute stroke patients eligible for thrombolysis – an evaluation of ambulance on-scene time

Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion

Contact Info

Product

Resources

About