Less is more - The Finnish Prehospital Stroke Scale prospective validation

OBJECTIVES

The current bifurcation of the acute stroke care pathway requires prehospital separation of strokes caused by large vessel occlusion. The first four binary items of the Finnish Prehospital Stroke Scale (FPSS) identify stroke in general, while the fifth binary item alone identifies stroke due to large vessel occlusion. The straightforward design is both easy for paramedics and statistically beneficial. We implemented FPSS based Western Finland Stroke Triage Plan, including medical districts of a comprehensive stroke center and four primary stroke centers.

PATIENTS AND METHODS

The prospective study population was consecutive recanalization candidates transported to the comprehensive stroke center within the first six months of implementing the stroke triage plan. Cohort 1 consisted of n=302 thrombolysis- or endovascular treatment candidates transported from the comprehensive stroke center hospital district. Cohort 2 comprised ten endovascular treatment candidates transferred directly to the comprehensive stroke center from the medical districts of four primary stroke centers.

RESULTS

In Cohort 1, FPSS sensitivity for large vessel occlusion was 0.66, specificity 0.94, positive predictive value 0.70, and negative predictive value 0.93. Of the ten Cohort 2 patients, nine had large vessel occlusion, and one had an intracerebral hemorrhage.

CONCLUSIONS

FPSS is straightforward enough to be implemented in primary care services to identify candidates for endovascular treatment and thrombolysis. When used by paramedics, it predicted two-thirds of large vessel occlusions with the highest specificity and positive predictive value reported to date.

Emergency medicine residents in the implementation of thrombolysis for acute ischemic stroke

BACKGROUND

Traditionally, neurologists have been in charge of thrombolytic treatment of ischemic stroke. In 2013, emergency medicine residents started working in the frontline at the Central Hospital of Central Finland (CHCF). They were trained to evaluate and give thrombolytic treatment to acute ischemic stroke patients out of hours, with the possibility of consulting a neurologist.

MATHERIALS AND METHODS

Retrospective study of acute stroke patients in CHCF, who received thrombolytic therapy during 2012 and 2014. In 2012 thrombolytic treatment was initiated by neurologists only, In 2014 emergency medicine registrars initiated thrombolytic therapy out of hours.

RESULTS

The annual number of tissue plasminogen activator treatment (tPA) increased and door-to needle time significantly decreased from 2012 to 2014. There were no significant differences in complications and overall functional capacity at 3 months.

CONCLUSIONS

This study indicated that training of emergency medicine physicians to give thrombolytic treatment to acute ischemic stroke is feasible and may shorten in-hospital delays.

Straightforward emergency care

Emergency department is a showroom of its organization and an entry point to the hospital. The negative impact of sluggish processes and overcrowding in the ED is well acknowledged. Several tools can be used to improve patient flow in the ED. The specialty of emergency medicine is a crucial element which enables the establishment of stable, well-educated staff in the ED.

Recent PCB accidents in Finland

Twenty-eight polychlorinated biphenyl (PCB) accidents were recorded during a 1-year period in Finland. They comprised leaks, fires or explosions of capacitors. Some of the explosions and fires gave rise to high concentrations of PCBs in air and of PCBs and tetrachlorodibenzofurans (TCDFs), including 2,3,7,8-TCDF, on surfaces. One large explosion is described in detail, and biomedical data and findings of this case are compared with those of smaller accidents in Finland.