151
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Turc G. Mothership or drip-and-ship in the era of thrombectomy: can we use prehospital clinical scales as a compass? Eur J Neurol 2017; 24:543-544. [DOI: 10.1111/ene.13261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Turc
- Department of Neurology; Hôpital Sainte Anne; Paris France
- INSERM U894; Paris France
- Department of Neurology; Center for Stroke Research Berlin; Charité-Universitätsmedizin; Berlin Germany
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152
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Zhao H, Coote S, Pesavento L, Churilov L, Dewey HM, Davis SM, Campbell BC. Large Vessel Occlusion Scales Increase Delivery to Endovascular Centers Without Excessive Harm From Misclassifications. Stroke 2017; 48:568-573. [PMID: 28232591 DOI: 10.1161/strokeaha.116.016056] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Clinical large vessel occlusion (LVO) triage scales were developed to identify and bypass LVO to endovascular centers. However, there are concerns that scale misclassification of patients may cause excessive harm. We studied the settings where misclassifications were likely to occur and the consequences of these misclassifications in a representative stroke population.
Methods—
Prospective data were collected from consecutive ambulance-initiated stroke alerts at 2 stroke centers, with patients stratified into typical (LVO with predefined severe syndrome and non-LVO without) or atypical presentations (opposite situations). Five scales (Rapid Arterial Occlusion Evaluation [RACE], Los Angeles Motor Scale [LAMS], Field Assessment Stroke Triage for Emergency Destination [FAST-ED], Prehospital Acute Stroke Severity scale [PASS], and Cincinnati Prehospital Stroke Severity Scale [CPSSS]) were derived from the baseline National Institutes of Health Stroke Scale scored by doctors and analyzed for diagnostic performance compared with imaging.
Results—
Of a total of 565 patients, atypical presentations occurred in 31 LVO (38% of LVO) and 50 non-LVO cases (10%). Most scales correctly identified >95% of typical presentations but <20% of atypical presentations. Misclassification attributable to atypical presentations would have resulted in 4 M1/internal carotid artery occlusions, with National Institutes of Health Stroke Scale score ≥6 (5% of LVO) being missed and 9 non-LVO infarcts (5%) bypassing the nearest thrombolysis center.
Conclusions—
Atypical presentations accounted for the bulk of scale misclassifications, but the majority of these misclassifications were not detrimental, and use of LVO scales would significantly increase timely delivery to endovascular centers, with only a small proportion of non-LVO infarcts bypassing the nearest thrombolysis center. Our findings, however, would require paramedics to score as accurately as doctors, and this translation is made difficult by weaknesses in current scales that need to be addressed before widespread adoption.
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Affiliation(s)
- Henry Zhao
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
| | - Skye Coote
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
| | - Lauren Pesavento
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
| | - Leonid Churilov
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
| | - Helen M. Dewey
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
| | - Stephen M. Davis
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
| | - Bruce C.V. Campbell
- From the Department of Medicine and Neurology, Royal Melbourne Hospital (H.Z., L.P., S.M.D., B.C.V.C.), and The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne, Parkville, Australia; and Eastern Health Clinical School, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (S.C., H.M.D.)
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153
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Derex L, Cho TH. Mechanical thrombectomy in acute ischemic stroke. Rev Neurol (Paris) 2017; 173:106-113. [PMID: 28238346 DOI: 10.1016/j.neurol.2016.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 01/13/2023]
Abstract
Recent randomized trials have demonstrated the efficacy of stent retriever thrombectomy, in association with intravenous thrombolysis, in acute ischemic stroke related to the occlusion of the distal internal carotid artery or the proximal middle cerebral artery within six hours of symptom onset. Mechanical thrombectomy should be performed as soon as possible after symptom onset. High age alone should not be considered as a contraindication for mechanical thrombectomy. Mechanical thrombectomy is recommended in acute ischemic stroke patients with large vessel occlusions and salvageable brain tissue if intravenous thrombolysis is contraindicated. Re-organization of stroke care systems is needed to provide rapid access to endovascular therapy equitably to all eligible patients.
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Affiliation(s)
- L Derex
- Unité neurovasculaire, service de neurologie, hôpital Neurologique de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
| | - T-H Cho
- Unité neurovasculaire, service de neurologie, hôpital Neurologique de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
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154
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Affiliation(s)
- Patrik Michel
- From the Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland
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155
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Kim JT, Chung PW, Starkman S, Sanossian N, Stratton SJ, Eckstein M, Pratt FD, Conwit R, Liebeskind DS, Sharma L, Restrepo L, Tenser MK, Valdes-Sueiras M, Gornbein J, Hamilton S, Saver JL. Field Validation of the Los Angeles Motor Scale as a Tool for Paramedic Assessment of Stroke Severity. Stroke 2017; 48:298-306. [DOI: 10.1161/strokeaha.116.015247] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region.
Methods—
We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy–Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals.
Results—
Among 1632 acute cerebrovascular disease patients (age 70±13 years, male 57.5%), time from onset to prehospital LAMS was median 30 minutes (interquartile range 20–50), onset to early postarrival (EPA) LAMS was 145 minutes (interquartile range 119–180), and onset to EPA National Institutes of Health Stroke Scale was 150 minutes (interquartile range 120–180). Between the prehospital and EPA assessments, LAMS scores were stable in 40.5%, improved in 37.6%, and worsened in 21.9%. In tests of convergent validity, against the EPA National Institutes of Health Stroke Scale, correlations were
r
=0.49 for the prehospital LAMS and
r
=0.89 for the EPA LAMS. Prehospital LAMS scores did diverge from the prehospital Glasgow Coma Scale,
r
=−0.22. Predictive accuracy (adjusted C statistics) for nondisabled 3-month outcome was as follows: prehospital LAMS, 0.76 (95% confidence interval 0.74–0.78); EPA LAMS, 0.85 (95% confidence interval 0.83–0.87); and EPA National Institutes of Health Stroke Scale, 0.87 (95% confidence interval 0.85–0.88).
Conclusions—
In this multicenter, prospective, prehospital study, the LAMS showed good to excellent convergent, divergent, and predictive validity, further establishing it as a validated instrument to characterize stroke severity in the field.
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Affiliation(s)
- Joon-Tae Kim
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Pil-Wook Chung
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Sidney Starkman
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Nerses Sanossian
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Samuel J. Stratton
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Marc Eckstein
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Frank D. Pratt
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Robin Conwit
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - David S. Liebeskind
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Latisha Sharma
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Lucas Restrepo
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - May-Kim Tenser
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Miguel Valdes-Sueiras
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Jeffrey Gornbein
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Scott Hamilton
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
| | - Jeffrey L. Saver
- From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen
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156
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Miller JB, Merck LH, Wira CR, Meurer WJ, Schrock JW, Nomura JT, Siket MS, Madsen TE, Wright DW, Panagos PD, Lewandowski C. The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care. Ann Emerg Med 2017; 69:192-201. [DOI: 10.1016/j.annemergmed.2016.06.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/16/2016] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
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157
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Scheitz JF, Abdul-Rahim AH, MacIsaac RL, Cooray C, Sucharew H, Kleindorfer D, Khatri P, Broderick JP, Audebert HJ, Ahmed N, Wahlgren N, Endres M, Nolte CH, Lees KR. Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion. Stroke 2017; 48:290-297. [PMID: 28087804 DOI: 10.1161/strokeaha.116.014431] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/14/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies.
Methods—
Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012–May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery).
Results—
Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8–5.3). All 3 face–arm–speech–time test (FAST) items identified LAVO with high sensitivity. Addition of the item best gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity.
Conclusions—
Simple modification of the face–arm–speech–time score or evaluating the NIHSS symptom profile may help to stratify patients’ risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required.
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Affiliation(s)
- Jan F Scheitz
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.).
| | - Azmil H Abdul-Rahim
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Rachael L MacIsaac
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Charith Cooray
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Heidi Sucharew
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Dawn Kleindorfer
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Pooja Khatri
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Joseph P Broderick
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Heinrich J Audebert
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Niaz Ahmed
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Nils Wahlgren
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Matthias Endres
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Christian H Nolte
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
| | - Kennedy R Lees
- From the Center for Stroke Research Berlin (J.F.S., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.J.A., M.E., C.H.N.), Excellence Cluster NeuroCure (M.E.), German Center for Cardiovascular Research (DZHK) (M.E.), and German Center for Neurodegenerative Diseases (DZNE) (M.E.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Stroke Research, Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., R.L.M., K.R.L.); Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Solna, Sweden (C.C., N.A., N.W.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (H.S.); and Department of Emergency Medicine, University of Cincinnati, College of Medicine, OH (D.K., P.K., J.P.B.)
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158
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Abstract
Although stroke declined from the third to fifth most common cause of death in the United States, the annual incidence and overall prevalence continue to increase. Since the available US Food and Drug Administration-approved treatment options are time dependent, improving early stroke care may have more of a public health impact than any other phase of care. Timely and efficient stroke treatment should be a priority for emergency department and prehospital providers. This article discusses currently available and emerging treatment options in acute ischemic stroke focusing on the preservation of salvageable brain tissue, minimizing complications, and secondary prevention.
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Affiliation(s)
- Matthew S Siket
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, 55 Claverick Street, 2nd Floor, Providence, RI 02903, USA.
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159
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McMullan JT, Katz B, Broderick J, Schmit P, Sucharew H, Adeoye O. Prospective Prehospital Evaluation of the Cincinnati Stroke Triage Assessment Tool. PREHOSP EMERG CARE 2017; 21:481-488. [DOI: 10.1080/10903127.2016.1274349] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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160
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Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Ximénez-Carrillo Á, Zapata-Wainberg G, Álvarez-Fraga J, Barriga FJ, Castillo L, Carneado-Ruiz J, Díaz-Guzman J, Egido-Herrero J, de Felipe A, Fernández-Ferro J, Frade-Pardo L, García-Gallardo Á, García-Pastor A, Gil-Núñez A, Gómez-Escalonilla C, Guillán M, Herrero-Infante Y, Masjuan-Vallejo J, Ortega-Casarrubios MÁ, Vivancos-Mora J, Díez-Tejedor E. The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network. Eur J Neurol 2017; 24:509-515. [DOI: 10.1111/ene.13233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - B. Fuentes
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | | | | | | - J. Álvarez-Fraga
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | - F. J. Barriga
- Department of Neurology; Alcorcon University Hospital Foundation; Madrid Spain
| | - L. Castillo
- Department of Neurology; Alcorcon University Hospital Foundation; Madrid Spain
| | - J. Carneado-Ruiz
- Department of Neurology; Puerta de Hierro-Majadahonda University Hospital; Madrid Spain
| | - J. Díaz-Guzman
- Department of Neurology; 12 de Octubre University Hospital; Madrid Spain
| | - J. Egido-Herrero
- Department of Neurology; San Carlos University Hospital; Madrid Spain
| | - A. de Felipe
- Department of Neurology; Ramón y Cajal University Hospital; Madrid Spain
| | - J. Fernández-Ferro
- Department of Neurology; Rey Juan Carlos University Hospital; Madrid Spain
| | - L. Frade-Pardo
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | | - A. García-Pastor
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | - A. Gil-Núñez
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | | | - M. Guillán
- Department of Neurology; Rey Juan Carlos University Hospital; Madrid Spain
| | | | - J. Masjuan-Vallejo
- Department of Neurology; Ramón y Cajal University Hospital; Madrid Spain
| | | | - J. Vivancos-Mora
- Department of Neurology; La Princesa University Hospital; Madrid Spain
| | - E. Díez-Tejedor
- Department of Neurology; La Paz University Hospital; Madrid Spain
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161
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Carrera D, Campbell BC, Cortés J, Gorchs M, Querol M, Jiménez X, Millán M, Dávalos A, Pérez de la Ossa N. Predictive Value of Modifications of the Prehospital Rapid Arterial Occlusion Evaluation Scale for Large Vessel Occlusion in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2017; 26:74-77. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/18/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022] Open
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162
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Lima FO, Silva GS, Nogueira RG. Response by Lima et al to Letter Regarding Article, "Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes". Stroke 2016; 47:e275-e276. [PMID: 27834749 DOI: 10.1161/strokeaha.116.015296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fabricio O Lima
- Department of Neurology Universidade de Fortaleza Ceará, Brazil
| | - Gisele S Silva
- Neurovascular Service, Department of Neurology Federal University of São Paulo Brazil nf
| | - Raul G Nogueira
- Department of Neurology, Neuroendovascular, ICU, and Stroke Emory University Atlanta, GA
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163
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164
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Pérez de la Ossa N, Ribó M, Jiménez X, Abilleira S. Prehospital Scales to Identify Patients With Large Vessel Occlusion. Stroke 2016; 47:2877-2878. [DOI: 10.1161/strokeaha.116.014911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Natalia Pérez de la Ossa
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Marc Ribó
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Xavier Jiménez
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Sònia Abilleira
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
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165
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Adeoye O, Katz B, McMullan J. Letter by Adeoye et al Regarding Article, “Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion: Design and Comparison With Other Scales”. Stroke 2016; 47:e242. [DOI: 10.1161/strokeaha.116.014844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Opeolu Adeoye
- Department of Emergency Medicine, University of Cincinnati, OH
| | - Brian Katz
- Department of Neurology, Ohio Health, Columbus
| | - Jason McMullan
- Department of Emergency Medicine, University of Cincinnati, OH
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166
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Hastrup S, Johnsen SP, Andersen G. Response by Hastrup et al to Letter Regarding Article, “Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion: Design and Comparison With Other Scales”. Stroke 2016; 47:e243. [DOI: 10.1161/strokeaha.116.014879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sidsel Hastrup
- Department of Neurology Aarhus University Hospital Denmark
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167
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Abstract
PURPOSE OF REVIEW With the recent demonstration of the effectiveness of rapid recanalization of large vessel occlusions in acute ischemic stroke, it is important to assess the current status of pre and intrahospital workflow for acute stroke. RECENT FINDINGS We will review trends in the evaluation and treatment of acute stroke and offer suggestions for how best to advance the workflow for acute stroke care in the coming years. SUMMARY Future research is needed for: field use of clinical scores for predicting large vessel occlusions, telemedicine to facilitate prehospital triage, and pre and intrahospital processes for optimizing stroke care delivery.
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168
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Hastrup S, Andersen G, Simonsen CZ. Letter by Hastrup et al Regarding Article, “Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion”. Stroke 2016; 47:e229. [DOI: 10.1161/strokeaha.116.014290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sidsel Hastrup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Z. Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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169
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Jovin TG, Albers GW, Liebeskind DS. Stroke Treatment Academic Industry Roundtable: The Next Generation of Endovascular Trials. Stroke 2016; 47:2656-65. [PMID: 27586682 DOI: 10.1161/strokeaha.116.013578] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The STAIR (Stroke Treatment Academic Industry Roundtable) meeting aims to advance acute stroke therapy development through collaboration between academia, industry, and regulatory institutions. In pursuit of this goal and building on recently available level I evidence of benefit from endovascular therapy (ET) in large vessel occlusion stroke, STAIR IX consensus recommendations were developed that outline priorities for future research in ET. METHODS Three key directions for advancing the field were identified: (1) development of systems of care for ET in large vessel occlusion stroke, (2) development of therapeutic approaches adjunctive to ET, and (3) exploring clinical benefit of ET in patient population insufficiently studied in recent trials. Methodological issues such as optimal trial design and outcome measures have also been addressed. RESULTS Development of systems of care strategies should be geared both toward ensuring broad access to ET for eligible patients and toward shortening time to reperfusion to the minimum possible. Adjunctive therapy development includes neuroprotective approaches, adjuvant microcirculatory/collateral enhancing strategies, and periprocedural management. Future research priorities seeking to expand the eligible patient population are to determine benefit of ET in patients presenting beyond conventional time windows, in patients with large baseline ischemic core lesions, and in other important subgroups. CONCLUSIONS Research priorities in ET for large vessel occlusion stroke are to improve systems of care, investigate effective adjuvant therapies, and explore whether patient eligibility could be expanded.
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Affiliation(s)
- Tudor G Jovin
- From the Stroke Institute and UPMC Center for Neuroendovascular Therapy, Pittsburgh, PA (T.G.J.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stroke Center, Stanford University School of Medicine, Palo Alto, CA (G.W.A.); and Department of Neurology, Neurovascular Imaging Research Core, UCLA Stroke Center, University of California, Los Angeles (D.S.L.).
| | - Gregory W Albers
- From the Stroke Institute and UPMC Center for Neuroendovascular Therapy, Pittsburgh, PA (T.G.J.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stroke Center, Stanford University School of Medicine, Palo Alto, CA (G.W.A.); and Department of Neurology, Neurovascular Imaging Research Core, UCLA Stroke Center, University of California, Los Angeles (D.S.L.)
| | - David S Liebeskind
- From the Stroke Institute and UPMC Center for Neuroendovascular Therapy, Pittsburgh, PA (T.G.J.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stroke Center, Stanford University School of Medicine, Palo Alto, CA (G.W.A.); and Department of Neurology, Neurovascular Imaging Research Core, UCLA Stroke Center, University of California, Los Angeles (D.S.L.)
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170
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Broderick JP, Abir M. Transitions of Care for Stroke Patients: Opportunities to Improve Outcomes. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2016; 8:S190-2. [PMID: 26515208 DOI: 10.1161/circoutcomes.115.002288] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph P Broderick
- From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B.); Department of Emergency Medicine, University of Michigan, Ann Arbor (M.A.); and RAND Corporation, Santa Monica, CA (M.A.).
| | - Mahshid Abir
- From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH (J.P.B.); Department of Emergency Medicine, University of Michigan, Ann Arbor (M.A.); and RAND Corporation, Santa Monica, CA (M.A.)
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171
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Fiehler J, Cognard C, Gallitelli M, Jansen O, Kobayashi A, Mattle HP, Muir KW, Mazighi M, Schaller K, Schellinger PD. European recommendations on organisation of interventional care in acute stroke (EROICAS). Eur Stroke J 2016; 1:155-170. [PMID: 31008277 DOI: 10.1177/2396987316659033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Center, Hamburg, Germany
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Mauro Gallitelli
- Emergency Department, Ospedale "Santi Giovanni e Paolo", Venice, Italy
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Adam Kobayashi
- 2nd Department of Neurology and Interventional Stroke and Cerebrovascular Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Mikael Mazighi
- Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, Paris, France
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva, Medical Center, Geneva, Switzerland
| | - Peter D Schellinger
- Departments of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
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172
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Fiehler J, Cognard C, Gallitelli M, Jansen O, Kobayashi A, Mattle HP, Muir KW, Mazighi M, Schaller K, Schellinger PD. European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS). Int J Stroke 2016; 11:701-16. [DOI: 10.1177/1747493016647735] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Center, Hamburg, Germany
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Mauro Gallitelli
- Emergency Department, Ospedale “Santi Giovanni e Paolo”, Venice, Italy
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Adam Kobayashi
- 2nd Department of Neurology and Interventional Stroke and Cerebrovascular Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Mikael Mazighi
- Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, Paris, France
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva, Medical Center, Geneva, Switzerland
| | - Peter D Schellinger
- Departments of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
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173
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Hastrup S, Damgaard D, Johnsen SP, Andersen G. Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion. Stroke 2016; 47:1772-6. [DOI: 10.1161/strokeaha.115.012482] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/25/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Sidsel Hastrup
- From the Department of Neurology, Aarhus University Hospital, Aarhus, Denmark (S.H., D.D., G.A.); and Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark (S.H., S.P.J.)
| | - Dorte Damgaard
- From the Department of Neurology, Aarhus University Hospital, Aarhus, Denmark (S.H., D.D., G.A.); and Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark (S.H., S.P.J.)
| | - Søren Paaske Johnsen
- From the Department of Neurology, Aarhus University Hospital, Aarhus, Denmark (S.H., D.D., G.A.); and Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark (S.H., S.P.J.)
| | - Grethe Andersen
- From the Department of Neurology, Aarhus University Hospital, Aarhus, Denmark (S.H., D.D., G.A.); and Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark (S.H., S.P.J.)
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Lima FO, Silva GS, Furie KL, Frankel MR, Lev MH, Camargo ÉCS, Haussen DC, Singhal AB, Koroshetz WJ, Smith WS, Nogueira RG. Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes. Stroke 2016; 47:1997-2002. [PMID: 27364531 DOI: 10.1161/strokeaha.116.013301] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. METHODS The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale was based on items of the National Institutes of Health Stroke Scale (NIHSS) with higher predictive value for LVOS and tested in the Screening Technology and Outcomes Project in Stroke (STOPStroke) cohort, in which patients underwent computed tomographic angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery-M1, middle cerebral artery-2, or basilar arteries. Patients with partial, bihemispheric, and anterior+posterior circulation occlusions were excluded. Receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of FAST-ED were compared with the NIHSS, Rapid Arterial Occlusion Evaluation (RACE) scale, and Cincinnati Prehospital Stroke Severity (CPSS) scale. RESULTS LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the receiver operating characteristic curve: FAST-ED=0.81 as reference; NIHSS=0.80, P=0.28; RACE=0.77, P=0.02; and CPSS=0.75, P=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity of 0.89, positive predictive value of 0.72, and negative predictive value of 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, and 0.79, and CPSS ≥2 of 0.56, 0.85, 0.65, and 0.78, respectively. CONCLUSIONS FAST-ED is a simple scale that if successfully validated in the field, it may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.
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Affiliation(s)
- Fabricio O Lima
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Gisele S Silva
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Karen L Furie
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Michael R Frankel
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Michael H Lev
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Érica C S Camargo
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Diogo C Haussen
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Aneesh B Singhal
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Walter J Koroshetz
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Wade S Smith
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.)
| | - Raul G Nogueira
- From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).
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175
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Heldner MR, Hsieh K, Broeg-Morvay A, Mordasini P, Bühlmann M, Jung S, Arnold M, Mattle HP, Gralla J, Fischer U. Clinical prediction of large vessel occlusion in anterior circulation stroke: mission impossible? J Neurol 2016; 263:1633-40. [PMID: 27272907 DOI: 10.1007/s00415-016-8180-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Mirjam R Heldner
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Kety Hsieh
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Anne Broeg-Morvay
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Monika Bühlmann
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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176
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Cooray C, Mazya M, Bottai M, Dorado L, Skoda O, Toni D, Ford GA, Wahlgren N, Ahmed N. External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke. Stroke 2016; 47:1493-9. [DOI: 10.1161/strokeaha.116.012802] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
ASTRAL (Acute Stroke Registry and Analysis of Lausanne) and DRAGON (includes dense middle cerebral artery sign, prestroke modified Rankin Scale score, age, glucose, onset to treatment, National Institutes of Health Stroke Scale score) are 2 recently developed scores for predicting functional outcome after acute stroke in unselected acute ischemic stroke patients and in patients treated with intravenous thrombolysis, respectively. We aimed to perform external validation of these scores to assess their predictive performance in the large multicentre Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.
Methods—
We calculated the ASTRAL and DRAGON scores in 36 131 and 33 716 patients, respectively, registered in Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register between 2003 and 2013. The proportion of patients with 3-month modified Rankin Scale scores of 3 to 6 was observed for each score point and compared with the predicted proportion according to the risk scores. Calibration was assessed using calibration plots, and predictive performance was assessed using area under the curve of the receiver operating characteristic. Multivariate logistic regression coefficients for the variables in the 2 scores were compared with the original derivation cohorts.
Results—
The ASTRAL showed an area under the curve of 0.790 (95% confidence interval, 0.786–0.795) and the DRAGON an area under the curve of 0.774 (95% confidence interval, 0.769–0.779). All ASTRAL parameters except range of visual fields and all DRAGON parameters were significantly associated with functional outcome in multivariate analysis.
Conclusions—
The ASTRAL and DRAGON scores show an acceptable predictive performance. ASTRAL does not require imaging-data and therefore may have an advantage for the use in prehospital patient assessment. Prospective studies of both scores evaluating the impact of their use on patient outcomes after intravenous thrombolysis and endovascular therapy are needed.
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Affiliation(s)
- Charith Cooray
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Michael Mazya
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Matteo Bottai
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Laura Dorado
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Ondrej Skoda
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Danilo Toni
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Gary A. Ford
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Nils Wahlgren
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
| | - Niaz Ahmed
- From the Department of Clinical Neurosciences, Karolinska Institutet and Department of Neurology Karolinska University Hospital, Stockholm, Sweden (C.C., M.M., N.W., N.A.); Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.B.); Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain (L.D.); Department of Neurology, 3rd Medical Faculty, Charles University,
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Turc G, Maïer B, Naggara O, Seners P, Isabel C, Tisserand M, Raynouard I, Edjlali M, Calvet D, Baron JC, Mas JL, Oppenheim C. Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion. Stroke 2016; 47:1466-72. [PMID: 27125526 DOI: 10.1161/strokeaha.116.013144] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Guillaume Turc
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Benjamin Maïer
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Olivier Naggara
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Pierre Seners
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Clothilde Isabel
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Marie Tisserand
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Igor Raynouard
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Myriam Edjlali
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - David Calvet
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Jean-Claude Baron
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Jean-Louis Mas
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
| | - Catherine Oppenheim
- From the Departments of Neurology (G.T., B.M., P.S., C.I., I.R., D.C., J.-C.B., J.-L.M.) and Radiology (O.N., M.T., M.E., C.O.), Hôpital Sainte-Anne, Paris, France; and Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France (G.T., B.M., O.N., P.S., C.I., M.T., I.R., M.E., D.C., J.-C.B., J.-L.M., C.O.)
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Mokin M, Snyder KV, Siddiqui AH, Levy EI, Hopkins LN. Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care. J Am Coll Cardiol 2016; 67:2645-55. [DOI: 10.1016/j.jacc.2015.12.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
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Mohamad NF, Hastrup S, Rasmussen M, Andersen MS, Johnsen SP, Andersen G, Simonsen CZ. Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion. Eur Stroke J 2016; 1:85-92. [PMID: 31008269 DOI: 10.1177/2396987316647857] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/11/2016] [Indexed: 11/17/2022] Open
Abstract
Objective In large-vessel occlusion, endovascular therapy is superior to medical management alone in achieving recanalisation. Reducing time delays to revascularisation in patients with large-vessel occlusion is important to improving outcome. Patients and methods A campaign was implemented in the Central Denmark Region targeting the identification of patients with large-vessel occlusion for direct transport to a comprehensive stroke centre. Time delays and outcomes before and after the intervention were assessed. Results A total of 476 patients (153 pre-intervention and 323 post-intervention) were included. They were treated with either intravenous tissue plasminogen activator or endovascular treatment (alone or in combination with intravenous tissue plasminogen activator). Endovascular therapy patients' median system delay was reduced from 234 to 185 min (adjusted relative risk delay 0.79 (95% confidence interval: 0.67-0.93)). The in-hospital delay was the main driver with an adjusted relative risk delay of 0.76 (confidence interval: 0.62-0.94), while pre-hospital delay was almost significantly reduced with an adjusted relative delay of 0.86 (confidence interval: 0.71-1.04). This was achieved without increasing the intravenous tissue plasminogen activator-treated patients' delay. Significantly more patients treated with endovascular therapy in the post-interventional period achieved functional independence (62% versus 43%), corresponding to an adjusted odds ratio of 3.08 (95% confidence interval: 1.08-8.78). Conclusion Direct transfer of patients with suspected large-vessel occlusion to a comprehensive stroke centre leads to shorter treatment times for endovascular therapy patients and is, in turn, associated with an increase in functional independence. We recorded no adverse effects on intravenous tissue plasminogen activator treatment times or outcome.
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Affiliation(s)
- Niwar Faisal Mohamad
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sidsel Hastrup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Rasmussen
- Department of Neuroanaestesia, Aarhus University Hospital, Aarhus, Denmark.,Helicopter Emergency Medical Service, Danish Air Ambulance, Denmark
| | - Mikkel Strømgaard Andersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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EMS and Acute Stroke Care: Evidence for Policies to Reduce Delays to Definitive Treatments. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0502-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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183
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Kummer BR, Gialdini G, Sevush JL, Kamel H, Patsalides A, Navi BB. External Validation of the Cincinnati Prehospital Stroke Severity Scale. J Stroke Cerebrovasc Dis 2016; 25:1270-1274. [PMID: 26971037 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Cincinnati Prehospital Stroke Severity Scale (CPSSS) was recently developed to predict large-vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). In its derivation study, which consisted of patients enrolled in thrombolysis and endovascular therapy trials, the CPSSS had excellent discriminatory performance. We sought to externally validate the CPSSS in an independent cohort. METHODS Using our institution's prospective stroke registry, we calculated CPSSS scores for all patients diagnosed with AIS at Weill Cornell Medical Center in 2013 and 2014. The primary outcome was presence of LVO and the secondary outcome was a National Institutes of Health Stroke Scale (NIHSS) score of 15 or higher. Harrell's c-statistic was calculated to determine the CPSSS score's discriminatory performance. Using the previously defined cut-point of 2 or higher (range 0-4), we evaluated the test properties of the CPSSS for predicting study outcomes. RESULTS Among 751 patients with AIS, 664 had vessel imaging and were included in the final analysis. Of these patients, 80 (14.2%) had LVOs and 117 (17.6%) had an NIHSS score of 15 or higher. The median CPSSS score was 0 (interquartile range 0-1) and 133 patients (20%) had scores of 2 or higher. c-statistic was .85 (95% confidence interval [CI] .81-.90) for predicting LVO and .94 (95% CI .92-.97) for predicting an NIHSS score of 15 or higher. Using a cut-point of 2 or higher, the CPSSS was 70.0% sensitive and 86.8% specific for predicting LVO, and 87.2% sensitive and 94.3% specific for predicting an NIHSS score of 15 or higher. CONCLUSIONS In a cohort of patients with AIS treated at a tertiary-care stroke center, the CPSSS had reasonable sensitivity and specificity for predicting LVO and severe stroke. Future studies should aim to prospectively validate the score in emergency responders.
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Affiliation(s)
- Benjamin R Kummer
- Department of Neurology, Weill Cornell Medical College, New York, New York.
| | - Gino Gialdini
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Jennifer L Sevush
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Athos Patsalides
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
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Glober NK, Sporer KA, Guluma KZ, Serra JP, Barger JA, Brown JF, Gilbert GH, Koenig KL, Rudnick EM, Salvucci AA. Acute Stroke: Current Evidence-based Recommendations for Prehospital Care. West J Emerg Med 2016; 17:104-28. [PMID: 26973735 PMCID: PMC4786229 DOI: 10.5811/westjem.2015.12.28995] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization. Results Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification. Conclusion Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.
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Affiliation(s)
- Nancy K Glober
- University of California San Diego, Department of Emergency Medicine, San Diego, California
| | - Karl A Sporer
- EMS Medical Directors Association of California, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Kama Z Guluma
- University of California San Diego, Department of Emergency Medicine, San Diego, California
| | - John P Serra
- University of California San Diego, Department of Emergency Medicine, San Diego, California
| | - Joe A Barger
- EMS Medical Directors Association of California, California
| | - John F Brown
- EMS Medical Directors Association of California, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Gregory H Gilbert
- EMS Medical Directors Association of California, California; Stanford University, Department of Emergency Medicine, Stanford, California
| | - Kristi L Koenig
- EMS Medical Directors Association of California, California; University of California Irvine, Center for Disaster Medical Sciences, Orange, California
| | - Eric M Rudnick
- EMS Medical Directors Association of California, California
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Southerland AM, Johnston KC, Molina CA, Selim MH, Kamal N, Goyal M. Suspected Large Vessel Occlusion: Should Emergency Medical Services Transport to the Nearest Primary Stroke Center or Bypass to a Comprehensive Stroke Center With Endovascular Capabilities? Stroke 2016; 47:1965-7. [PMID: 26896433 DOI: 10.1161/strokeaha.115.011149] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew M Southerland
- From the Departments of Neurology (A.M.S., K.C.J.) and Public Health Sciences (A.M.S., K.C.J.), University of Virginia Health System, Charlottesville; Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain (C.A.M.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.); and Departments of Clinical Neurosciences (N.K., M.G.) and Radiology (M.G.), University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Karen C Johnston
- From the Departments of Neurology (A.M.S., K.C.J.) and Public Health Sciences (A.M.S., K.C.J.), University of Virginia Health System, Charlottesville; Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain (C.A.M.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.); and Departments of Clinical Neurosciences (N.K., M.G.) and Radiology (M.G.), University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.
| | - Carlos A Molina
- From the Departments of Neurology (A.M.S., K.C.J.) and Public Health Sciences (A.M.S., K.C.J.), University of Virginia Health System, Charlottesville; Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain (C.A.M.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.); and Departments of Clinical Neurosciences (N.K., M.G.) and Radiology (M.G.), University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Magdy H Selim
- From the Departments of Neurology (A.M.S., K.C.J.) and Public Health Sciences (A.M.S., K.C.J.), University of Virginia Health System, Charlottesville; Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain (C.A.M.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.); and Departments of Clinical Neurosciences (N.K., M.G.) and Radiology (M.G.), University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Noreen Kamal
- From the Departments of Neurology (A.M.S., K.C.J.) and Public Health Sciences (A.M.S., K.C.J.), University of Virginia Health System, Charlottesville; Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain (C.A.M.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.); and Departments of Clinical Neurosciences (N.K., M.G.) and Radiology (M.G.), University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Mayank Goyal
- From the Departments of Neurology (A.M.S., K.C.J.) and Public Health Sciences (A.M.S., K.C.J.), University of Virginia Health System, Charlottesville; Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain (C.A.M.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.); and Departments of Clinical Neurosciences (N.K., M.G.) and Radiology (M.G.), University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.
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Teleb MS, Ver Hage A, Carter J, Jayaraman MV, McTaggart RA. Stroke vision, aphasia, neglect (VAN) assessment-a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices. J Neurointerv Surg 2016; 9:122-126. [PMID: 26891627 PMCID: PMC5284468 DOI: 10.1136/neurintsurg-2015-012131] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 01/12/2023]
Abstract
Background Identification of emergent large vessel occlusion (ELVO) stroke has become increasingly important with the recent publications of favorable acute stroke thrombectomy trials. Multiple screening tools exist but the length of the examination and the false positive rate range from good to adequate. A screening tool was designed and tested in the emergency department using nurse responders without a scoring system. Methods The vision, aphasia, and neglect (VAN) screening tool was designed to quickly assess functional neurovascular anatomy. While objective, there is no need to calculate or score with VAN. After training participating nurses to use it, VAN was used as an ELVO screen for all stroke patients on arrival to our emergency room before physician evaluation and CT scan. Results There were 62 consecutive code stroke activations during the pilot study. 19 (31%) of the patients were VAN positive and 24 (39%) had a National Institutes of Health Stroke Scale (NIHSS) score of ≥6. All 14 patients with ELVO were either VAN positive or assigned a NIHSS score ≥6. While both clinical severity thresholds had 100% sensitivity, VAN was more specific (90% vs 74% for NIHSS ≥6). Similarly, while VAN and NIHSS ≥6 had 100% negative predictive value, VAN had a 74% positive predictive value while NIHSS ≥6 had only a 58% positive predictive value. Conclusions The VAN screening tool accurately identified ELVO patients and outperformed a NIHSS ≥6 severity threshold and may best allow clinical teams to expedite care and mobilize resources for ELVO patients. A larger study to both validate this screening tool and compare with others is warranted.
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Affiliation(s)
| | - Anna Ver Hage
- Neurosciences Department, Banner Health, Mesa, Arizona, USA
| | | | - Mahesh V Jayaraman
- Department of Diagnostic Imaging Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ryan A McTaggart
- Department of Diagnostic Imaging Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
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Gory B, Riva R, Labeyrie P, Turjman F. Stent retriever thrombectomy for acute ischemic stroke: Indications, results and management in 2015. Diagn Interv Imaging 2016; 97:141-9. [DOI: 10.1016/j.diii.2015.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/06/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022]
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188
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Alatas ÖD, Gürger M, Ateşçelik M, Yildiz M, Demir CF, Ekingen E, Kalayci M, Ilhan N, Acar E. Neuron-Specific Enolase, S100 Calcium-Binding Protein B, and Heat Shock Protein 70 Levels in Patients With Intracranial Hemorrhage. Medicine (Baltimore) 2015; 94:e2007. [PMID: 26559295 PMCID: PMC4912289 DOI: 10.1097/md.0000000000002007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022] Open
Abstract
The authors evaluated neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B), and heat shock protein 70 (HSP 70) levels and their relationships with in-hospital mortality, Glasgow Coma Scale (GCS) scores, and National Institute of Health Stroke Scale (NIHSS) scores. In total, 35 patients older than 18 years were presented to our emergency department and were diagnosed with non-traumatic intracranial hemorrhage (ICH) and 32 healthy controls were included. Blood samples were drawn on days 0 and 5. S100 calcium-binding protein B and HSP levels were significantly higher in patients than in controls on days 0 and 5. Neuron-specific enolase levels were higher in patients than in controls on day 0, but there was no significant difference on day 5. S100 calcium-binding protein B was negatively correlated with GCS, whereas it was positively correlated with NIHSS and bleeding volume. There was also a negative correlation between NSE and GCS, but it was not statistically significant. In addition, no significant correlation was found in terms of bleeding volume or NIHSS. Heat shock protein 70 was negatively correlated with GCS and positively correlated with bleeding volume and NIHSS, but these results were not statistically significant. S100 calcium-binding protein B and HSP 70 levels were significantly higher in those who died compared with survivors. The areas under the curve of S100 B, NSE, and HSP 70 for mortality were 0.635, 0.477, and 0.770, respectively. Neuron-specific enolase, S100B, and HSP 70 levels are simple, inexpensive, and objective measures in cases of ICH. These tests can be used to support an assessment for screening ICH patients with clinical scoring systems, such as GCS and NIHSS.
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Affiliation(s)
- Ömer Doğan Alatas
- From the Department of Emergency Medicine, Mugla Sitki Kocman University, Mugla (ODA, EA); Department of Emergency Medicine (MG, MA, MY); Department of Neurology, Firat University, Medicine School, Elazig (CFD); Department of Emergency Medicine, Batman Region State Hospital, Batman (EE); Department of Biochemistry, Elazig Training Hospital (MK); and Department of Biochemistry, Firat University, Medicine School, Elazig, Turkey (NI)
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Härtig F, Purrucker J, Hametner C, Poli S. [From stroke to reperfusion : How can we be faster?]. Med Klin Intensivmed Notfmed 2015; 111:703-707. [PMID: 26459456 DOI: 10.1007/s00063-015-0092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/01/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND During the last two decades major efforts in clinical research have led to the establishment of intravenous thrombolysis as the first line acute therapy for ischemic stroke. More recently, data from successful phase III trials have provided proof of the efficiency of mechanical recanalization in acute stroke. The fact that the efficiency of the available therapies can be increased through faster delivery is well documented; however, many institutions dealing with the emergency care of stroke patients lack organizational or infrastructural arrangements to optimize time efficiency in the diagnostic and therapeutic workup. CONCLUSION Many of these arrangements have been well evaluated, can be implemented at reasonable costs and have been proven to increase the beneficial effects of thrombolytic therapy.
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Affiliation(s)
- F Härtig
- Abteilung Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72070, Tübingen, Deutschland
| | - J Purrucker
- Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - C Hametner
- Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - S Poli
- Abteilung Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72070, Tübingen, Deutschland.
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Gory B, Lehot JJ, Gueugniaud PY, Dubien PY, Lamy B, Riva R, Labeyrie PE, Derex L, Turjman F. Thrombectomie mécanique de l’infarctus cérébral : pourquoi une prise en charge ultrarapide est nécessaire ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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