Prehospital triage for endovascular clot removal in acute stroke patients

Abstract

AimTo establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city‐wide transportation system using the Maria Prehospital Stroke Scale (MPSS), a novel prehospital stroke scale for emergency medical technicians (EMTs) to predict the likelihood of thrombolytic therapy after transportation.MethodsKawasaki City, Japan, has six comprehensive stroke centers (CSCs) and six primary stroke centers (PSCs). In CSCs, endovascular therapy can be carried out 24 h a day, 7 days a week, but not in PSCs. There is no “drip and ship” protocol for further endovascular therapy from PSCs to CSCs. We determined the predictive value of MPSS scoring by the EMTs for the performance of endovascular therapy after transportation.ResultsThere were 2031 patients (mean age, 71.1 ± 13.3 years) registered from April 2012 to March 2015. Multivariate logistic regression analysis indicated that the MPSS score and type of stroke center were independent predictors for performance of endovascular therapy. In particular, the odds ratio (OR) for endovascular therapy was significant for MPSS score 3 (OR, 2.914; 95% confidence interval (CI), 1.152–7.372; P = 0.024), MPSS score 4 (OR, 5.474; 95%CI, 2.300–13.029; P = 0.000), and MPSS score 5 (OR, 11.459; 95%CI, 4.334–30.296; P = 0.000) when MPSS score 1 was set as a reference. The diagnostic accuracy of the MPSS score evaluated by EMTs was 0.689 (95%CI, 0.627–0.751).ConclusionsPrehospital triage using MPSS scores evaluated by EMTs can predict the likelihood of performance of endovascular therapy after transportation, and may become a tool offering a flexible solution for designing a new transportation protocol.

Validated Pre-Hospital Stroke Scales to Predict Large Vessel Occlusion: A Systematic Review

“…Thirty-one studies underwent full-text review after title and abstracts were screened. Studies by Gupta et al (33), Hastrup et al (20), Katz et al ( 21), Lima et al (34), Nazliel et al ( 22) Suzuki et al (23) and Taqi et al (35) were excluded as they were retrospectively derived or tested scores. Carrera et al (24) was excluded as it was a retrospectively derived score using a prospectively gathered cohort.…”

“…In recent years the literature has focussed on tools that have a higher specificity for acute strokes with LVO. The Rapid Arterial Occlusion Evaluation (RACE), Los Angeles Motor Score (LAMS), Cincinnati Pre-hospital Stroke Severity Score (CPSSS), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), National Institute of Stroke Scale 8 (NIHSS-8) and a host of other scores have been investigated (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Typically, scales are derived from retrospective data sets with very few undergoing prospective field validation.…”

Drip-and-Ship Model for Thrombectomy in Stroke Patients with Large-Vessel Occlusion

“…Compared to Suzhou, the Japanese city Kawasaki is 142.7 km 2 and has 1.431 million inhabitants with 12 hospitals providing IV recombinant tissue plasminogen activator (rt-PA) treatment, and half of these provide 24-h/7-day intravascular treatment. Although Japan had no formal definition and classification of the PSCs and CSCs and the agreement of drip-and-ship model, 6 hospitals met our PSC standard and 6 hospitals qualified as CSCs [23]. Similarly, the South Korea Department of Health initiated a regional CSC program to reduce stroke morbidity and mortality in 2008.…”

Helistroke: neurointerventionalist helicopter transport for interventional stroke treatment: proof of concept and rationale

“…Transfer times, however, are not insignificant, and averaged 100 min in the SWIFT-PRIME trial,6 which may result in brain loss and worsened outcomes. Presently, methods to reduce transfer times and rates include in-field stroke scales to ascertain probable large vessel occlusions so patients can be brought directly to neurointerventional-capable centers,7 8 or in-field assessments using imaging housed within the ambulance to triage patients and initiate medical therapy while still en route to the hospital 10…”