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Stroke prehospital

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https://www.readbyqxmd.com/read/28713330/access-to-thrombolysis-for-non-resident-and-resident-stroke-patients-a-registry-based-comparative-study-from-berlin
#1
Ludwig Schlemm, Guillaume Turc, Heinrich J Audebert, Martin Ebinger
OBJECTIVES: Stroke can happen to people away from home. It is unknown whether non-resident and resident stroke patients have equal access to thrombolysis. MATERIALS AND METHODS: Consecutive patients cared for by the Stroke Emergency Mobile between 2011 and 2016 after prompting suspicion of acute stroke during the emergency call were included in our registry. Patients were categorized as residents or non-residents based on their main address. Clinical characteristics, thrombolysis rates, and time intervals from symptom onset/last seen well to alarm and to thrombolysis were compared between groups adjusting for age, pre-stroke modified Rankin Scale (mRS) score, and National Institutes of Health Stroke Scale (NIHSS) score...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28661784/identifying-key-words-in-9-1-1-calls-for-stroke-a-mixed-methods-approach
#2
Christopher T Richards, Baiyang Wang, Eddie Markul, Frank Albarran, Doreen Rottman, Neelum T Aggarwal, Patricia Lindeman, Leslee Stein-Spencer, Joseph M Weber, Kenneth S Pearlman, Katie L Tataris, Jane L Holl, Diego Klabjan, Shyam Prabhakaran
OBJECTIVES: Identifying stroke during a 9-1-1 call is critical to timely prehospital care. However, emergency medical dispatchers (EMDs) recognize stroke in less than half of 9-1-1 calls, potentially due to the words used by callers to communicate stroke signs and symptoms. We hypothesized that callers do not typically use words and phrases considered to be classical descriptors of stroke, such as focal neurologic deficits, but that a mixed-methods approach can identify words and phrases commonly used by 9-1-1 callers to describe acute stroke victims...
June 29, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28655816/optimal-transport-destination-for-ischemic-stroke-patients-with-unknown-vessel-status-use-of-prehospital-triage-scores
#3
Eckhard Schlemm, Martin Ebinger, Christian H Nolte, Matthias Endres, Ludwig Schlemm
BACKGROUND AND PURPOSE: Patients with acute ischemic stroke (AIS) and large vessel occlusion may benefit from direct transportation to an endovascular capable comprehensive stroke center (mothership approach) as opposed to direct transportation to the nearest stroke unit without endovascular therapy (drip and ship approach). The optimal transport strategy for patients with AIS and unknown vessel status is uncertain. The rapid arterial occlusion evaluation scale (RACE, scores ranging from 0 to 9, with higher scores indicating higher stroke severity) correlates with the National Institutes of Health Stroke Scale and was developed to identify patients with large vessel occlusion in a prehospital setting...
June 27, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28649936/berlin-prehospital-or-usual-delivery-of-acute-stroke-care-study-protocol
#4
Martin Ebinger, Peter Harmel, Christian H Nolte, Ulrike Grittner, Bob Siegerink, Heinrich J Audebert
Rationale Prehospital stroke care in specialized ambulances increases thrombolysis rates, reduces alarm-to-treatment times, and improves the prehospital triage. Preliminary analyses suggest cost-effectiveness. However, scientific proof of better functional outcome compared to usual care is still lacking. Aim To prove better functional outcomes after deployment of the Stroke Emergency Mobile compared to regular ambulances. Sample size estimates A sample size of 686 patients will be required in each arm (Stroke Emergency Mobile group vs...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28646851/development-of-an-education-campaign-to-reduce-delays-in-pre-hospital-response-to-stroke
#5
Caterina Caminiti, Peter Schulz, Barbara Marcomini, Elisa Iezzi, Silvia Riva, Umberto Scoditti, Andrea Zini, Giovanni Malferrari, Maria Luisa Zedde, Donata Guidetti, Enrico Montanari, Mario Baratti, Licia Denti
BACKGROUND: Systematic reviews call for well-designed trials with clearly described intervention components to support the effectiveness of educational campaigns to reduce patient delay in stroke presentation. We herein describe the systematic development process of a campaign aimed to increase stroke awareness and preparedness. METHODS: Campaign development followed Intervention Mapping (IM), a theory- and evidence-based tool, and was articulated in two phases: needs assessment and intervention development...
June 24, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28622071/survival-in-out-of-hospital-rapid-sequence-intubation-of-non-traumatic-brain-pathologies
#6
Pieter Francsois Fouche, Paul Andrew Jennings, Karen Smith, Malcolm Boyle, Gabriel Blecher, Jonathan Knott, Mani Raji, Pamela Rosengarten, Michael Roberto Augello, Stephen Bernard
INTRODUCTION: Rapid sequence intubation (RSI) is not only used in traumatic brain injuries in the out-of-hospital setting, but also for non-traumatic brain pathologies (NTBP) such as brain tumors, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumors, aneurysms, brain hemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions, and alcohol and drug overdose. Previous research suggests that RSI is common in non-traumatic coma, but with an unknown prevalence of NTBP in those that receive RSI...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28597634/prehospital-path-in-acute-stroke
#7
Kashif Waqar Faiz, Antje Sundseth, Bente Thommessen, Ole Morten Rønning
No abstract text is available yet for this article.
June 2017: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
https://www.readbyqxmd.com/read/28592375/an-educational-intervention-allows-for-greater-prehospital-recognition-of-acute-stroke
#8
Tara K Henry-Morrow, Bryan D Nelson, Erin Conahan, Claranne Mathiesen, Bernadette Glenn-Porter, Matthew T Niehaus, Lauren M Porter, Mitchell R Gesell, Gregory T Monaghan, Jeanne L Jacoby
No abstract text is available yet for this article.
May 24, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28579511/streamlining-workflow-for-endovascular-mechanical-thrombectomy-lessons-learned-from-a-comprehensive-stroke-center
#9
REVIEW
Hongjin Wang, Arthur Thevathasan, Richard Dowling, Steven Bush, Peter Mitchell, Bernard Yan
BACKGROUND: Recently, 5 randomized controlled trials confirmed the superiority of endovascular mechanical thrombectomy (EMT) to intravenous thrombolysis in acute ischemic stroke with large-vessel occlusion. The implication is that our health systems would witness an increasing number of patients treated with EMT. However, in-hospital delays, leading to increased time to reperfusion, are associated with poor clinical outcomes. This review outlines the in-hospital workflow of the treatment of acute ischemic stroke at a comprehensive stroke center and the lessons learned in reduction of in-hospital delays...
June 1, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28538247/the-positive-predictive-value-of-an-ambulance-prealert-for-stroke-and-transient-ischaemic-attack
#10
Craig W Brown, Mary J Macleod
OBJECTIVE: Therapeutic options for ischaemic stroke, such as thrombolysis or thrombectomy, are time sensitive. Multiple innovations have been established to reduce the symptom-to-needle time. One such innovation is the prealerting of emergency department (ED) or stroke unit staff by prehospital personnel of suspected stroke patients. The diagnosis of stroke can sometimes be difficult, with stroke mimics being a recognized issue. The prealert mobilizes ED, stroke and imaging personnel, which, for a true-positive, improves door-to-needle times...
May 19, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28495830/establishing-recommendations-for-stroke-systems-in-the-thrombectomy-era-the-upstate-new-york-stakeholder-proceedings
#11
Zainab Magdon-Ismail, Curtis Benesch, Jeremy T Cushman, Ian Brissette, Andrew M Southerland, Ethan S Brandler, Cemal B Sozener, Sue Flor, Roseanne Hemmitt, Kathleen Wales, Krystal Parrigan, Steven R Levine
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale...
July 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28492918/association-of-a-primary-stroke-center-protocol-for-suspected-stroke-by-large-vessel-occlusion-with-efficiency-of-care-and-patient-outcomes
#12
Ryan A McTaggart, Shadi Yaghi, Shawna M Cutting, Morgan Hemendinger, Grayson L Baird, Richard A Haas, Karen L Furie, Mahesh V Jayaraman
Importance: While prehospital triage to the closest comprehensive stroke center (CSC) may improve the delivery of care for patients with suspected emergent large-vessel occlusion (ELVO), efficient systems of care must also exist for patients with ELVO who first present to a primary stroke center (PSC). Objective: To describe the association of a PSC protocol focused on 3 key steps (early CSC notification based on clinical severity, vessel imaging at the PSC, and cloud-based image sharing) with the efficiency of care and the outcomes of patients with suspected ELVO who first present to a PSC...
July 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28457621/validation-of-the-national-institutes-of-health-stroke-scale-8-to-detect-large-vessel-occlusion-in-ischemic-stroke
#13
Jelle Demeestere, Carlos Garcia-Esperon, Longting Lin, Andrew Bivard, Timothy Ang, Nicolas R Smoll, Ashley Garnett, Allan Loudfoot, Ferdi Miteff, Neil Spratt, Mark Parsons, Christopher Levi
BACKGROUND: Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy. AIMS: We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO. METHODS: We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS)...
July 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28434773/mstroke-mobile-stroke-improving-acute-stroke-care-with-smartphone-technology
#14
Benjamin Y Andrew, Colleen M Stack, Julian P Yang, Jodi A Dodds
OBJECTIVE: This study aimed to evaluate the effect of method and time of system activation on clinical metrics in cases utilizing the Stop Stroke (Pulsara, Inc.) mobile acute stroke care coordination application. METHODS: A retrospective cohort analysis of stroke codes at 12 medical centers using Stop Stroke from March 2013 to May 2016 was performed. Comparison of metrics (door-to-needle time [DTN] and door-to-CT time [DTC], and rate of DTN ≤ 60 minutes [goal DTN]) was performed between subgroups based on method (emergency medical service [EMS] versus emergency department [ED]) and time of activation...
April 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28432194/diagnostic-value-of-prehospital-ecg-in-acute-stroke-patients
#15
Tobias Bobinger, Bernd Kallmünzer, Markus Kopp, Natalia Kurka, Martin Arnold, Stefan Heider, Stefan Schwab, Martin Köhrmann
OBJECTIVE: To investigate the diagnostic yield of prehospital ECG monitoring provided by emergency medical services in the case of suspected stroke. METHODS: Consecutive patients with acute stroke admitted to our tertiary stroke center via emergency medical services and with available prehospital ECG were prospectively included during a 12-month study period. We assessed prehospital ECG recordings and compared the results to regular 12-lead ECG on admission and after continuous ECG monitoring at the stroke unit...
May 16, 2017: Neurology
https://www.readbyqxmd.com/read/28413705/acute-stroke-alert-activation-emergency-service-use-and-reperfusion-therapy-in-sweden
#16
Marie Eriksson, Eva-Lotta Glader, Bo Norrving, Birgitta Stegmayr, Kjell Asplund
OBJECTIVES: Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. METHODS: This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. RESULTS: The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12...
April 2017: Brain and Behavior
https://www.readbyqxmd.com/read/28399897/prehospital-ambulance-stroke-test-pilot-study-of-a-novel-stroke-test
#17
Gunnar Andsberg, Magnus Esbjörnsson, Arne Olofsson, Arne Lindgren, Bo Norrving, Mia von Euler
BACKGROUND: There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS). METHODS: The PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0-19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting...
April 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28389617/a-dedicated-spanish-language-line-increases-enrollment-of-hispanics-into-prehospital-clinical-research
#18
Nerses Sanossian, Lauren Rosenberg, David S Liebeskind, Sidney Starkman, Marc Eckstein, Samuel Stratton, Franklin D Pratt, Scott Hamilton, May Kim-Tenser, Latisha K Sharma, Lucas Restrepo, Miguel Valdes-Suieras, Robin Conwit, Jeffrey L Saver
BACKGROUND AND PURPOSE: Novel methods are needed to reduce the disparity of Hispanic enrollment in stroke clinical trials. Prehospital enrollment using a dedicated Spanish language line may help overcome this bias. METHODS: Subjects or legally authorized representatives provided information on race and ethnicity for all cases enrolled in the FAST-MAG clinical trial (Field Administration of Stroke Therapy-Magnesium), a prehospital phase 3 randomized study of intravenous magnesium for neuroprotection...
May 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28339314/an-analysis-of-ems-and-ed-detection-of-stroke
#19
Ian Medoro, David C Cone
BACKGROUND AND PURPOSE: Studies have shown a reduction in time-to-CT and improved process measures when EMS personnel notify the ED of a "stroke alert" from the field. However, there are few data on the accuracy of these EMS stroke alerts. The goal of this study was to examine diagnostic test performance of EMS and ED stroke alerts and related process measures. METHODS: The EMS and ED records of all stroke alerts in a large tertiary ED from August 2013-January 2014 were examined and data abstracted by one trained investigator, with data accuracy confirmed by a second investigator for 15% of cases...
July 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28275084/reduction-in-time-to-treatment-in-prehospital-telemedicine-evaluation-and-thrombolysis
#20
MULTICENTER STUDY
Ather Taqui, Russell Cerejo, Ahmed Itrat, Farren B S Briggs, Andrew P Reimer, Stacey Winners, Natalie Organek, Andrew B Buletko, Lila Sheikhi, Sung-Min Cho, Maureen Buttrick, Megan M Donohue, Zeshaun Khawaja, Dolora Wisco, Jennifer A Frontera, Andrew N Russman, Fredric M Hustey, Damon M Kralovic, Peter Rasmussen, Ken Uchino, Muhammad S Hussain
OBJECTIVE: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. METHODS: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT...
April 4, 2017: Neurology
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