Stroke care: initial data from a county-based bypass protocol for patients with acute stroke

Abstract

BackgroundEarly identification and transfer of patients with acute stroke to a primary or comprehensive stroke center results in favorable outcomes.ObjectiveTo describe implementation and results of an emergency medical service (EMS)-driven stroke protocol in Lucas County, Ohio.MethodAll county EMS personnel (N=464) underwent training in the Rapid Arterial oCclusion Evaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke and a RACE score ≥5 were taken to a facility that offered advanced therapy, was implemented in July 2015. During the 6-month study period, 109 RAs were activated. Time efficiencies, diagnostic accuracy, and mechanical thrombectomy (MT) outcomes were compared with standard ‘stroke-alert’ (N=142) patients from the preceding 6 months.ResultsAn increased treatment rate (25.6% vs 12.6%, p<0.05) and improved time efficiency (median door-to-CT 10 vs 28 min, p<0.05; door-to-needle 46 vs 75 min, p<0.05) of IV tissue plasminogen activator within the RA cohort was achieved. The rate of MT (20.1% vs 7.7%, p=0.06) increased and treatment times improved, including median arrival-to-puncture (68 vs 128 min, p=0.04) and arrival-to-recanalization times (101 vs 205 min, p=0.001) in favor of the RA cohort. A non-significant trend towards improved outcome (50% vs 36.4%, p=0.3) in the RA cohort was noted. The RA protocol also showed improved diagnostic specificity for ischemic stroke (52.3% vs 30.1%, p<0.05).ConclusionsOur results indicate that EMS adaptation of the RA protocol within Lucas County is feasible and effective for early triage and treatment of patients with stroke. Using this protocol, we can significantly improve treatment times for both systemic thrombolysis and MT.

Cognitive Rehabilitation for Memory Deficits After Stroke

“…Кроме того, шкалу RACE стали использовать и в других регионах, например в Толедо, штат Огайо, где пациентов с оценкой по шкале RACE ≥5 баллов направляли непосредственно в центр эндоваскулярной хирургии. При этом частота проведения ЭВТ возросла с 7,7 до 20,1% и произошло повышение эффективности временных затрат [8].…”

Pomona Large Vessel Occlusion Screening Tool for Prehospital and Emergency Room Settings

“…Some of the RACE items’ scorings are different from NIHSS scoring, which makes it harder for nurses in the emergency room setting who routinely use the NIHSS [7]. Moreover, the RACE scale had an 80% false-positive rate in detecting LVO, but its use significantly decreased door to CT, door to needle, door to groin, and door to recanalization times [18]. Although a high false-positive rate presents significant clinical problems, we think that using a screening tool is better than no tool to guide emergency medical services workers in the triage of patients.…”

A review of acute ischemic stroke triage protocol evidence: a context for discussion

“…In 2016, a group of investigators in northwestern Ohio published a study comparing patients with AIS who had arrived at the regional ECC, after implementation of a protocol permitting prehospital triage directly to an ECC, with historical controls 16. While the study design was primarily intended to test whether the RACE score, a prehospital stroke scale intended to identify ELVO,14 was effective in triaging ELVO patients to ECCs, the results have important implications for AIS triage models.…”