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Garcia-Esperon C, Ostman C, Walker FR, Chew B, Edwards S, Emery J, Bendall J, Alanati K, Dunkerton S, Starling de Barros R, Amin M, Gangadharan S, Lillicrap T, Parsons M, Levi CR, Spratt NJ. The Hunter-8 scale prehospital triage workflow for identification of large vessel occlusion and brain haemorrhage. PREHOSP EMERG CARE 2022:1-7. [PMID: 36053543 DOI: 10.1080/10903127.2022.2120134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ObjectiveThe Hunter-8 prehospital stroke scale predicts large vessel occlusion in hyperacute ischemic stroke patients (LVO) at hospital admission. We wished to test its performance in the hands of paramedics as part of a prehospital triage algorithm. We aimed to determine a) the proportion of patients identified by the Hunter-8 algorithm, receiving reperfusion therapies, b) whether a call to stroke team improved this, and c) performance for LVO detection using an expanded LVO definition.MethodsA prehospital workflow combining pre-morbid functional status, time from symptom onset, and the Hunter-8 scale was implemented from July 2019. A telephone call to the stroke team was prompted for potential treatment candidates. Classic LVO was defined as a proximal middle cerebral artery (MCA-M1), terminal internal carotid artery, or tandem occlusion. Extended LVO added proximal MCA-M2 and basilar occlusions.ResultsFrom July 2019 to April 2021, there were 363 Hunter-8 activations, 320 analysed: 181 (56.6%) had confirmed ischemic strokes, 13 (4.1%) transient ischemic attack, 91 (28.5%) stroke mimics, and 35 (10.9%) intracranial haemorrhage. Fifty-two patients (16.3%) received reperfusion therapies, 35 with Hunter-8 ≥ 8. The stroke doctor changed the final destination for 76 patients (23.7%), and five received reperfusion therapies. The AUCs for classic and extended LVO were 0.73 (95% CI 0.66-0.79) and 0.72 (95% CI 0.65-0.77), respectively.ConclusionThe Hunter-8 workflow resulted in 28.7% of confirmed ischemic stroke patients receiving reperfusion therapies, with no secondary transfers to the comprehensive stroke centre. The role of communication with stroke team needs to be further explored.
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Affiliation(s)
- C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - C Ostman
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia
| | - F R Walker
- College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Bla Chew
- Department of Neurology, John Hunter Hospital, Australia
| | - S Edwards
- New South Wales Ambulance, Rozelle, Australia
| | - J Emery
- New South Wales Ambulance, Rozelle, Australia
| | - J Bendall
- Department of Neurology, John Hunter Hospital, Australia.,New South Wales Ambulance, Rozelle, Australia
| | - K Alanati
- Department of Neurology, John Hunter Hospital, Australia
| | - S Dunkerton
- Department of Neurology, John Hunter Hospital, Australia
| | | | - M Amin
- Department of Neurology, John Hunter Hospital, Australia
| | - S Gangadharan
- Department of Neurology, John Hunter Hospital, Australia
| | - T Lillicrap
- Hunter Medical Research Institute, Newcastle, Australia
| | - M Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,University of New South Wales South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - C R Levi
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - N J Spratt
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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