The Cincinnati Prehospital Stroke Scale Compared to Stroke Severity Tools for Large Vessel Occlusion Stroke Prediction

Crowe, Remle P.; Myers, Jennifer; Fernández, Antonio R. Martínez; Bourn, Scott S.; McMullan, Jason T.

doi:10.1080/10903127.2020.1725198

Cited by 23 publications

(24 citation statements)

References 29 publications

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“…Overall predictive characteristics of first prehospital REMS for ED and in‐hospital patient dispositions were moderate and in line with widely used prehospital screening instruments for conditions such as stroke 31 . As previous authors have reported, 17,32 we found that prehospital REMS demonstrated slightly higher predictive power for ED mortality than ED discharge or hospital admission.…”

Section: Discussionsupporting

confidence: 88%

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Bourn¹,

Crowe²,

Fernández

et al. 2021

JACEP Open

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Objective The Rapid Emergency Medicine Score (REMS) has not been widely studied for use in predicting outcomes of COVID‐19 patients encountered in the prehospital setting. This study aimed to determine whether the first prehospital REMS could predict emergency department and hospital dispositions for COVID‐19 patients transported by emergency medical services. Methods This retrospective study used linked prehospital and hospital records from the ESO Data Collaborative for all 911‐initiated transports of patients with hospital COVID‐19 diagnoses from July 1 to December 31, 2020. We calculated REMS with the first recorded prehospital values for each component. We calculated area under the receiver operating curve (AUROC) for emergency department (ED) mortality, ED discharge, hospital mortality, and hospital length of stay (LOS). We determined optimal REMS cut‐points using test characteristic curves. Results Among 13,830 included COVID‐19 patients, median REMS was 6 (interquartile range [IQR]: 5‐9). ED mortality was <1% (n = 80). REMS ≥9 predicted ED death (AUROC 0.79). One‐quarter of patients (n = 3,419) were discharged from the ED with an optimal REMS cut‐point of ≤5 (AUROC 0.72). Eighteen percent (n = 1,742) of admitted patients died. REMS ≥8 optimally predicted hospital mortality (AUROC 0.72). Median hospital LOS was 8.3 days (IQR: 4.1‐14.8 days). REMS ≥7 predicted hospitalizations ≥3 days (AUROC 0.62). Conclusion Initial prehospital REMS was modestly predictive of ED and hospital dispositions for patients with COVID‐19. Prediction was stronger for outcomes more proximate to the first set of emergency medical services (EMS) vital signs. These findings highlight the potential value of first prehospital REMS for risk stratification of individual patients and system surveillance for resource planning related to COVID‐19.

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Section: Discussionsupporting

confidence: 88%

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Bourn¹,

Crowe²,

Fernández

et al. 2021

JACEP Open

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“…One explanation for this finding is that factors other than observed physiologic signs, including elements of the patient's medical or family history of disease, may influence hospital admission decisions (26,27). Overall, the AUROC of initial prehospital REMS for ED discharge versus admission, transfer, or death was similar to that observed for widely used stroke screening instruments (28). Meanwhile, the AUROC for overall patient mortality was high and similar to values observed in a study of REMS among prehospital patients in the United Kingdom (21).…”

Section: Accepted Manuscriptmentioning

confidence: 53%

“…While substantial research has been performed in the use of risk stratification tools to guide activation and appropriate destinations for patients with trauma (3)(4)(5), stroke (6)(7)(8)(9), or sepsis (10,11), there have been limited efforts to approximate risk and inform treatment and destination decisions for the broader EMS patient population. The Modified Early Warning Score (MEWS) (12) and the National Early Warning Score (NEWS) (13) have shown prognostic value in the prehospital setting as predictors of hospital mortality (14,15).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…The median initial prehospital REMS for patients who were discharged was 5 (IQR: 2-7) compared to 11 (IQR: 8-14) among patients who died in the ED. Patients admitted to the hospital had a median prehospital REMS of 7 (5)(6)(7)(8), while those who were transferred to another facility had a median prehospital REMS of 5 (2-7) ( Table 2). Approximately 11% of EMS patients in this analysis had an initial prehospital REMS of 0 and 85% of these patients were discharged from the ED (Table 3).…”

Section: Rems As a Predictor Of Ed Dischargementioning

confidence: 99%

“…The median initial prehospital REMS was lower among patients who survived to discharge (5, [IQR: 3-8]) compared to those who did not survive to discharge (9, [IQR: [6][7][8][9][10][11][12]). All patients with an initial prehospital REMS of 0 (11%) survived to discharge.…”

Section: Rems As a Predictor Of Overall Survival To Dischargementioning

confidence: 99%

See 2 more Smart Citations

Initial Prehospital Rapid Emergency Medicine Score (REMS) as a Predictor of Patient Outcomes

Crowe

Bourn

Fernández

et al. 2021

Prehospital Emergency Care

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Large Vessel Occlusion Stroke Detection in the Prehospital Environment

Patrick

Smith

Keenan

2021

Curr Emerg Hosp Med Rep

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Purpose of Review Endovascular therapy for acute ischemic stroke secondary to large vessel occlusion (LVO) is time-dependent. Prehospital patients with suspected LVO stroke should be triaged directly to specialized stroke centers for endovascular therapy. This review describes advances in LVO detection among prehospital suspected stroke patients. Recent Findings Clinical prehospital stroke severity tools have been validated in the prehospital setting. Devices including EEG, SSEPs, TCD, cranial accelerometry, and volumetric impedance phase-shift-spectroscopy have recently published data regarding LVO detection in hospital settings. Mobile stroke units bring thrombolysis and vessel imaging to patients. Summary The use of a prehospital stroke severity tool for LVO triage is now widely supported. Ease of use should be prioritized as there are no meaningful differences in diagnostic performance amongst tools. LVO diagnostic devices are promising, but none have been validated in the prehospital setting. Mobile stroke units improve patient outcomes and cost-effectiveness analyses are underway.

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The Cincinnati Prehospital Stroke Scale Compared to Stroke Severity Tools for Large Vessel Occlusion Stroke Prediction

Cited by 23 publications

References 29 publications

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Initial Prehospital Rapid Emergency Medicine Score (REMS) as a Predictor of Patient Outcomes

Large Vessel Occlusion Stroke Detection in the Prehospital Environment

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