Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China

Jiang, Bin; Ru, Xiaojuan; Sun, Haixin; Li, Hongmei; Sun, Dongling; Liu, Yuhui; Huang, Jiuyi; He, Li; Wang, Wenzhi

doi:10.1038/srep29795

Cited by 52 publications

(69 citation statements)

References 38 publications

(116 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the case of hemorrhagic stroke, early surgical interventions can be beneficial in selected patients [5,6]. Candidates for urgent interventions should be transported to an appropriately-equipped hospital, however, treatment can be delayed due to various reasons [7].…”

Section: Introductionmentioning

confidence: 99%

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

et al. 2020

View full text Add to dashboard Cite

Background Stroke recognition systems have been developed to reduce time delays, however, a comprehensive triaging score identifying stroke subtypes is needed to guide appropriate management. We aimed to develop a prehospital scoring system for rapid stroke recognition and identify stroke subtype simultaneously. Methods and findings In prospective database of regional emergency and stroke center, Clinical Information, Vital signs, and Initial Labs (CIVIL) of 1,599 patients suspected of acute stroke was analyzed from an automatically-stored electronic health record. Final confirmation was performed with neuroimaging. Using multiple regression analyses, we determined independent predictors of tier 1 (true-stroke or not), tier 2 (hemorrhagic stroke or not), and tier 3 (emergent large vessel occlusion [ELVO] or not). The diagnostic performance of the stepwise CIVIL scoring system was investigated using internal validation. A new scoring system characterized by a stepwise clinical assessment has been developed in three tiers. Tier 1: Seven CIVIL-AS 3 A 2 P items (total score from-7 to +6) were deduced for true stroke as Age (� 60 years); Stroke risks without Seizure or psychiatric disease, extreme Sugar; "any Asymmetry", "not Ambulating"; abnormal blood Pressure at a cutoff point � 1 with diagnostic sensitivity of 82.1%, specificity of 56.4%. Tier 2: Four items for hemorrhagic stroke were identified as the CIVIL-MAPS indicating Mental change, Age below 60 years, high blood Pressure, no Stroke risks with cut-point � 2 (sensitivity 47.5%, specificity 85.4%). Tier 3: For ELVO diagnosis: we applied with CIVIL-GFAST items (Gaze, Face, Arm, Speech) with cut-point � 3 (sensitivity 66.5%, specificity 79.8%). The main limitation of this study is its retrospective nature and require a prospective validation of the CIVIL scoring system.

show abstract

Section: Introductionmentioning

confidence: 99%

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The accuracy of these scales in such scenarios is limited, and it is currently estimated that up to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13311-019-00720-9) contains supplementary material, which is available to authorized users. 30% of stroke patients are misdiagnosed during initial presentation, leading to life-threatening delays in care [1][2][3]. Because of this, there has been a push for the identification of stroke-associated peripheral blood biomarkers which could be rapidly measured at the point-of-care to better inform early clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

High-Throughput Profiling of Circulating Antibody Signatures for Stroke Diagnosis Using Small Volumes of Whole Blood

et al. 2019

View full text Add to dashboard Cite

Accurate stroke recognition during triage can streamline care and afford patients earlier access to life-saving interventions. However, the tools currently available to clinicians for prehospital and early in-hospital identification of stroke are limited. The peripheral immune system is intricately involved in stroke pathology and thus may be targetable for the development of immunodiagnostics. In this preliminary study, we sought to determine whether the circulating antibody pool is altered early in stroke, and whether such alterations could be leveraged for diagnosis. One hundred microliters of peripheral whole blood was sampled from 19 ischemic stroke patients, 17 hemorrhagic stroke patients, and 20 stroke mimics in the acute phase of care. A custom-fabricated high-density peptide array comprising 125,000 unique probes was used to assess the binding characteristics of blood-borne antibodies, and a random forest-based approach was used to select a parsimonious set of probes with an optimal ability to discriminate between groups. The coordinate antibody binding intensities of the top 17 probes identified in our analysis displayed an ability to differentiate the total pool of stroke patients from stroke mimics with 92% sensitivity and 90% specificity, as well as detect hemorrhage with 88% sensitivity and 87% specificity, as determined using a same-set cross-validation. These preliminary findings suggest that stroke-associated alterations in the circulating antibody pool may have clinical utility for diagnosis during triage, and that such a possibility warrants further investigation.

show abstract

“…The pre-hospital stage covers a period in which the stroke symptoms and findings are noticed by the individual or the witness, it is decided to seek medical care and transfer to the hospital (6,7).The pre-hospital delay is also experienced at the stage of seeking medical care and transporting the patient. A study conducted in China calls attention to the fact that ambulance paramedics are incapable of diagnosing 1/3 of stroke cases and to the imperfections regarding this field (8).…”

Section: Introductionmentioning

confidence: 99%

Prehospital Stroke Diagnosis and Management

Yaman¹,

Boyraz²

2019

TÃ¼rk Beyin Damar Hast Derg

View full text Add to dashboard Cite

INTRODUCTION:This study was carried out as a cross-sectional study for the purpose of evaluating 112 teams working in the Aydın dependent to the Ministry of Health, for the correct diagnosis of stroke cases and their interventions before the hospital. METHODS: In the study, the incident reports, which were transferred to the hospital, were received from A2-type emergency health-stations located in the center of Aydın province. In the first phase of the study, 1453 incident reports were examined to determine the situation. In the light of the obtained data, the emergency medical team was trained for using "Cincinnati Prehospital Stroke Scale" in terms of stroke and diagnosis. In the second phase of the study 2029 incident reports (in total=3484 incidents) were examined to evaluate the efficiency of the training.) The data were analyzed through "Structured Questionnaire", "CPSS" and hospital emergency service records. Data analyses process was assessed by calculating sensitivity, specificity, and accuracy rates. RESULTS: In the first phase, 91 cases and in the second phase 55 cases were pre-diagnosed with stroke and transferred to hospital emergency services. In the hospital emergency services, 63 cases were diagnosed with stroke in the first phase, and 63 cases were diagnosed with stroke in the second phase. The examination of diagnosis similarity between the two groups showed that in the first phase, 69.9% of the cases which were diagnosed with stroke in emergency services were consistent with the diagnosis of the 112 emergency medical team. The findings showed that in the second phase, %38,1 of the cases which were diagnosed with stroke in emergency services was consistent with the diagnosis of the 112 emergency medical team..Furthermore, in the second phase, it was determined that among the 55 incidents that were prediagnosed with stroke by 112 emergency medical teams, only 30 (%54,5) of them were pre-diagnosed with CPSS. The results demonstrated that the CPSS sensitivity to true stroke pre-diagnosis was %47. On the other hand, the results revealed that the trainings have had a positive impact on respiration support, circulation support and medical support interventions provided to stroke pre-diagnosed cases. DISCUSSION and CONCLUSION: The research study revealed that 122 emergency medical teams have deficiencies in terms of true diagnosis of stroke cases in the pre-hospital phase, and therefore training support should be maintained.

show abstract

Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China

Cited by 52 publications

References 38 publications

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

Stepwise stroke recognition through clinical information, vital signs, and initial labs (CIVIL): Electronic health record-based observational cohort study

High-Throughput Profiling of Circulating Antibody Signatures for Stroke Diagnosis Using Small Volumes of Whole Blood

Prehospital Stroke Diagnosis and Management

Contact Info

Product

Resources

About