TY - JOUR
T1 - The Maryland Acute Stroke Emergency Medical Services Routing Pilot
T2 - Expediting Access to Thrombectomy for Stroke
AU - Haight, Taylor
AU - Tabaac, Burton
AU - Patrice, Kelly Ann
AU - Phipps, Michael S.
AU - Butler, Jaime
AU - Johnson, Brenda
AU - Aycock, Anna
AU - Toral, Linda
AU - Yarbrough, Karen L.
AU - Schrier, Chad
AU - Lawrence, Erin
AU - Goldszmidt, Adrian
AU - Marsh, Elisabeth B.
AU - Urrutia, Victor C.
N1 - Funding Information:
EM – receives funding from: NIH/NIA R21AG068802-01. Mindfulness Matters: Mindfulness Based Stress Reduction (MBSR) to Treat Post-Stroke Cognitive Dysfunction After Minor Stroke. 2018 American Heart Association Innovative Research Grant 18IPA34170313. Imaging the Network: Using MEG to Understand the Pathophysiology of Cognitive Deficits After Minor Stroke.
Funding Information:
We would like to thank Timothy P. Chizmar, MD, FACEP, State EMS Medical Director, MIEMSS. Funding. EM ? receives funding from: NIH/NIA R21AG068802-01. Mindfulness Matters: Mindfulness Based Stress Reduction (MBSR) to Treat Post-Stroke Cognitive Dysfunction After Minor Stroke. 2018 American Heart Association Innovative Research Grant 18IPA34170313. Imaging the Network: Using MEG to Understand the Pathophysiology of Cognitive Deficits After Minor Stroke.
Funding Information:
Conflict of Interest: VU received funding from Genentech Inc for two unrelated studies. As site PI for the TIMELESS trial and as PI of the OPTIMISTmain trial.
Publisher Copyright:
© Copyright © 2021 Haight, Tabaac, Patrice, Phipps, Butler, Johnson, Aycock, Toral, Yarbrough, Schrier, Lawrence, Goldszmidt, Marsh and Urrutia.
PY - 2021/8/31
Y1 - 2021/8/31
N2 - Background: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke caused by large vessel occlusion, but is not available at all stroke centers. Transfers between hospitals lead to treatment delays. Transport directly to a facility capable of MT based on a prehospital stroke severity scale score has been recommended, if transportation time is less than 30 min. Aims: We hypothesized that an Emergency Medical Services (EMS) routing algorithm for stroke, using the Los Angeles Motor Scale (LAMS) in the field, would improve time from last known well to MT, without causing patients to miss the IV Thrombolysis (IVT) window. Methods: An EMS algorithm in the Baltimore metro area using the LAMS was implemented. Patients suspected of having an acute stroke were assessed by EMS using the LAMS. Patients scoring 4 or higher and within 20 h from last known well, were transported directly to a Thrombectomy Center, if transport could be completed within 30 min. The algorithm was evaluated retrospectively with prospectively collected data at the Thrombectomy Centers. The primary outcome variables were proportion of patients with suspected stroke rerouted by EMS, proportion of rerouted ischemic stroke patients receiving MT, time to treatment, and whether the IVT window was missed. Results: A total of 303 patients were rerouted out of 2459 suspected stroke patients over a period of 6 months. Of diverted patients, 47% had acute ischemic stroke. Of these, 48% received an acute stroke treatment: 16.8% IVT, 17.5% MT, and 14% MT+IVT. Thrombectomy occurred 119 min earlier in diverted patients compared to patients transferred from other hospitals (P = 0.006). 55.3% of diverted patients undergoing MT and 38.2% of patients transferred from hospital to hospital were independent at 90 days (modified Rankin score 0–2) (P = 0.148). No patient missed the time window for IVT due to the extra travel time. Conclusions: In this retrospective analysis of prospectively acquired data, implementation of a pre-hospital clinical screening score to detect patients with suspected acute ischemic stroke due to large vessel occlusion was feasible. Rerouting patients directly to a Thrombectomy Center, based on the EMS algorithm, led to a shorter time to thrombectomy.
AB - Background: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke caused by large vessel occlusion, but is not available at all stroke centers. Transfers between hospitals lead to treatment delays. Transport directly to a facility capable of MT based on a prehospital stroke severity scale score has been recommended, if transportation time is less than 30 min. Aims: We hypothesized that an Emergency Medical Services (EMS) routing algorithm for stroke, using the Los Angeles Motor Scale (LAMS) in the field, would improve time from last known well to MT, without causing patients to miss the IV Thrombolysis (IVT) window. Methods: An EMS algorithm in the Baltimore metro area using the LAMS was implemented. Patients suspected of having an acute stroke were assessed by EMS using the LAMS. Patients scoring 4 or higher and within 20 h from last known well, were transported directly to a Thrombectomy Center, if transport could be completed within 30 min. The algorithm was evaluated retrospectively with prospectively collected data at the Thrombectomy Centers. The primary outcome variables were proportion of patients with suspected stroke rerouted by EMS, proportion of rerouted ischemic stroke patients receiving MT, time to treatment, and whether the IVT window was missed. Results: A total of 303 patients were rerouted out of 2459 suspected stroke patients over a period of 6 months. Of diverted patients, 47% had acute ischemic stroke. Of these, 48% received an acute stroke treatment: 16.8% IVT, 17.5% MT, and 14% MT+IVT. Thrombectomy occurred 119 min earlier in diverted patients compared to patients transferred from other hospitals (P = 0.006). 55.3% of diverted patients undergoing MT and 38.2% of patients transferred from hospital to hospital were independent at 90 days (modified Rankin score 0–2) (P = 0.148). No patient missed the time window for IVT due to the extra travel time. Conclusions: In this retrospective analysis of prospectively acquired data, implementation of a pre-hospital clinical screening score to detect patients with suspected acute ischemic stroke due to large vessel occlusion was feasible. Rerouting patients directly to a Thrombectomy Center, based on the EMS algorithm, led to a shorter time to thrombectomy.
KW - acute stroke
KW - emergency medical services
KW - healthcare delivery assessment
KW - large vessel occlusion
KW - mechanical thrombectomy
KW - routing protocol
UR - http://www.scopus.com/inward/record.url?scp=85115134268&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85115134268&partnerID=8YFLogxK
U2 - 10.3389/fneur.2021.663472
DO - 10.3389/fneur.2021.663472
M3 - Article
C2 - 34539541
AN - SCOPUS:85115134268
SN - 1664-2295
VL - 12
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 663472
ER -