Improved Prehospital Triage of Patients With Stroke in a Specialized Stroke Ambulance

Abstract

Background and Purpose— Specialized management of patients with stroke is not available in all hospitals. We evaluated whether prehospital management in the Stroke Emergency Mobile (STEMO) improves the triage of patients with stroke. Methods— STEMO is an ambulance staffed with a specialized stroke team and equipped with a computed tomographic scanner and point-of-care laboratory. We compared the prehospital triage of patients with suspected stroke at dispatcher level who either received STEMO care or conventional care. We assessed transport destination in patients with different diagnoses. Status at hospital discharge was used as short-term outcome. Results— From May 2011 to January 2013, 1804 of 6182 (29%) patients received STEMO care and 4378 of 6182 (71%) patients conventional care. Two hundred forty-five of 2110 (11.6%) patients with cerebrovascular events were sent to hospitals without Stroke Unit in conventional care when compared with 48 of 866 (5.5%; P <0.01%) patients in STEMO care. In patients with ischemic stroke, STEMO care reduced transport to hospitals without Stroke Unit from 10.1% (151 of 1497) to 3.9% (24 of 610; P <0.01). The delivery rate of patients with intracranial hemorrhage to hospitals without neurosurgery department was 43.0% (65 of 151) in conventional care and 11.3% (7 of 62) in STEMO care ( P <0.01). There was a slight trend toward higher rates of patients discharged home in neurological patients when cared by STEMO (63.5% versus 60.8%; P =0.096). Conclusions— The triage of patients with cerebrovascular events to specialized hospitals can be improved by STEMO ambulances. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01382862.

EMS and Acute Stroke Care: Evidence for Policies to Reduce Delays to Definitive Treatments

“…This ambulance, called the Stroke Emergency Mobile (STEMO), is staffed with a neurologist, a paramedic, and a radiology technician and includes a CT scanner. During their study period from 2011 to 2013, the use of STEMO increased the number of TPA treatments within the first hour from 4.9 to 31.0 % (p < 0.01) [24,25]. This concept has since been replicated in Cleveland with the development of a Mobile Stroke Unit (MSTU) and in Houston with the Mobile Stroke Unit [26,27].…”

Reconsidering Neuroprotection in the Reperfusion Era

“…With the advent of mobile stroke units that have CT scanners in the ambulance, we can envision that prehospital neuroprotection studies will be conducted in the future by stroke neurologists either physically present in the ambulance or by telemedicine. 41 Agents that have not been tested for safety in preclinical models of hemorrhage or that have any potential effect on coagulation would not be testable in the prehospital setting, not until after neuroimaging is obtained, necessitating a start in the hospital, after imaging and decisions on thrombolysis have been made. It is unlikely that an agent with these limitations could be tested less than an hour after symptom onset unless the study was conducted in a mobile stroke unit.…”

Letter by Uchino et al Regarding Article, “Art of Expertise in Stroke Telemedicine: Imaging and the Collaterome”

“…The editorial of this article by Dr Liebeskind is well written but has an error in relation to the article in discussion, by Wendt et al, 1,2 on the ability of mobile stroke unit (Stroke Emergency Mobile [STEMO]) to triage patients with stroke to the appropriate hospitals. We applaud the innovation and achievement in Berlin using STEMO, and we agree with Dr Liebeskind and STEMO study group that the mobile stroke unit has potential to be used beyond simply providing prehospital thrombolysis.…”

“…The editorial discusses that the STEMO group "demonstrated the effect of such telemedicine expertise on patients with both ischemic and hemorrhagic stroke." The methods in the article of Wendt et al 2 state that "STEMO is staffed with a neurologist, a paramedic, and a radiology technician." It used teleradiology, but an on-board neurologist clinician evaluated the patient in person.…”