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https://www.readbyqxmd.com/read/29317012/prehospital-identification-of-patients-with-a-final-hospital-diagnosis-of-stroke
#1
Elin Andersson, Linda Bohlin, Johan Herlitz, Annelie J Sundler, Zoltán Fekete, Magnus Andersson Hagiwara
Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29297735/national-assessment-of-quality-programs-in-emergency-medical-services
#2
Michael Redlener, Patrick Olivieri, George T Loo, Kevin Munjal, Michael T Hilton, Katya Trudeau Potkin, Michael Levy, Jeffrey Rabrich, Michael R Gunderson, Sabina A Braithwaite
OBJECTIVE: This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. METHODS: A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29297717/cincinnati-prehospital-stroke-scale-can-identify-large-vessel-occlusion-stroke
#3
Christopher T Richards, Ryan Huebinger, Katie L Tataris, Joseph M Weber, Laura Eggers, Eddie Markul, Leslee Stein-Spencer, Kenneth S Pearlman, Jane L Holl, Shyam Prabhakaran
OBJECTIVE: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), a simple assessment tool currently used by emergency medical services (EMS) providers, can be used to identify LVO. METHODS: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29291175/factors-delaying-management-of-acute-stroke-an-indian-scenario
#4
Siju V Abraham, S Vimal Krishnan, Fazil Thaha, Jayaraj Mymbilly Balakrishnan, Tom Thomas, Babu Urumese Palatty
Background and Purpose: The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India. Methods: All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected...
October 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29284734/impact-of-prehospital-triage-scales-to-detect-large-vessel-occlusion-on-resource-utilization-and-time-to-treatment
#5
Ludwig Schlemm, Martin Ebinger, Christian H Nolte, Matthias Endres
BACKGROUND AND PURPOSE: Prehospital stroke severity scales may help to triage acute ischemic stroke patients with large vessel occlusion (LVO) for direct transportation to a comprehensive stroke center. The impact on resource use and time to reperfusion treatment for patients with and without LVO is unknown. METHODS: Based on empirical distributions of stroke symptom severity, prehospital delay times, and stroke symptom severity-dependent likelihood of LVO, we simulate prehospital incidents of stroke-like symptoms in abstract geographical environments to estimate the impact of prehospital triage strategies based on different cutoffs of the rapid arterial occlusion evaluation scale...
December 28, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29278996/a-systematic-review-of-prehospital-telehealth-utilization
#6
Andrew S Winburn, Juliana J Brixey, James Langabeer, Tiffany Champagne-Langabeer
Objective There has been moderate evidence of telehealth utilization in the field of emergency medicine, but less is known about telehealth in prehospital emergency medical services (EMS). The objective of this study is to explore the extent, focus, and utilization of telehealth for prehospital emergency care through the analysis of published research. Methods The authors conducted a systematic literature review by extracting data from multiple research databases (including MEDLINE/PubMed, CINAHL Complete, and Google Scholar) published since 2000...
January 1, 2017: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/29239899/stroke-severity-quantification-by-critical-care-physicians-in-a-mobile-stroke-unit
#7
Maren R Hov, Jo Røislien, Thomas Lindner, Erik Zakariassen, Kristi C G Bache, Volker M Solyga, David Russell, Christian G Lund
BACKGROUND: Cerebral revascularization in acute stroke requires robust diagnostic tools close to symptom onset. The quantitative National Institute of Health Stroke Scale (NIHSS) is widely used in-hospital, whereas shorter and less specific stroke scales are used in the prehospital field. This study explored the accuracy and potential clinical benefit of using NIHSS prehospitally. PATIENTS AND METHODS: Thirteen anesthesiologists trained in prehospital critical care enrolled patients with suspected acute stroke in a mobile stroke unit...
December 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29237321/impact-of-onset-to-groin-puncture-time-within-three-hours-on-functional-outcomes-in-mechanical-thrombectomy-for-acute-large-vessel-occlusion
#8
Takahiro Ota, Yasuhiro Nishiyama, Satoshi Koizumi, Tomonari Saito, Masayuki Ueda, Nobuhito Saito
Introduction Endovascular treatment for acute ischemic stroke with acute large-vessel occlusion (ALVO) has established benefits, and rapid treatment is vital for mechanical thrombectomy in ALVO. Time from onset of stroke to groin puncture (OTP) is a practical and useful clinical marker, and OTP should be shortened to obtain the maximum benefit of thrombectomy. Objective The aim of the present study was to assess the impact of early treatment of anterior circulation stroke within three hours after symptom onset and to evaluate the role of OTP in determining outcomes after endovascular therapy...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29217362/rethinking-prehospital-stroke-notification-assessing-utility-of-emergency-medical-services-impression-and-cincinnati-prehospital-stroke-scale
#9
Stephen W English, Alejandro A Rabinstein, Jay Mandrekar, James P Klaas
BACKGROUND AND PURPOSE: Although prehospital stroke notification has improved stroke treatment, incorporation of these systems into existing infrastructure has resulted in new challenges. The goal of our study was to design an effective prehospital notification system that allows for early and accurate identification of patients presenting with acute stroke. METHODS: We conducted a retrospective single-center cohort study of patients presenting with suspicion of acute stroke from 2014 to 2015...
December 5, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29209269/if-time-is-brain-where-is-the-improvement-in-prehospital-time-after-stroke
#10
REVIEW
Jeremy N Pulvers, John D G Watson
Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29196201/specific-factors-to-predict-large-vessel-occlusion-in-acute-stroke-patients
#11
Masato Inoue, Ryuichi Noda, Shoji Yamaguchi, Yuta Tamai, Makiko Miyahara, Shunsuke Yanagisawa, Koichiro Okamoto, Tetsuo Hara, Sosuke Takeuchi, Kazunori Miki, Shigeru Nemoto
BACKGROUND: The effectiveness of thrombectomy for acute ischemic stroke has been established, and earlier treatment produces better outcomes. If possible to identify large-vessel occlusion (LVO) at the prehospital phase, eligible patients can be shipped directly to a hospital that can perform thrombectomy. The purpose of this study was to determine factors that are specific to LVO and can be known before hospital arrival. METHODS: The subjects were stroke patients during the period between July 2014 and June 2016, who had a National Institutes of Health Stroke Scale (NIHSS) score of 8 or higher and came to our hospital within 6 hours of onset...
November 28, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29182027/how-development-of-blood-biomarkers-could-benefit-prehospital-management-of-acute-stroke
#12
Perttu J Lindsberg, Markku Kuisma, Olli S Mattila
No abstract text is available yet for this article.
November 28, 2017: Biomarkers in Medicine
https://www.readbyqxmd.com/read/29175808/time-gain-needed-for-in-ambulance-telemedicine-cost-utility-model
#13
Alexis Valenzuela Espinoza, Stefanie Devos, Robbert-Jan van Hooff, Maaike Fobelets, Alain Dupont, Maarten Moens, Ives Hubloue, Door Lauwaert, Pieter Cornu, Raf Brouns, Koen Putman
BACKGROUND: Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine...
November 24, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/29174289/derivation-and-validation-of-the-emergency-medical-stroke-assessment-and-comparison-of-large-vessel-occlusion-scales
#14
Toby I Gropen, Amelia Boehme, Sheryl Martin-Schild, Karen Albright, Alyana Samai, Sammy Pishanidar, Nazli Janjua, Ethan S Brandler, Steven R Levine
BACKGROUND: This study aims to develop a simple scale to identify patients with prehospital stroke with large vessel occlusion (LVO), without losing sensitivity for other stroke types. METHODS: The Emergency Medical Stroke Assessment (EMSA) was derived from the National Institutes of Health Stroke Scale (NIHSS) items and validated for prediction of LVO in a separate cohort. We compared the EMSA with the 3-item stroke scale (3I-SS), Cincinnati Prehospital Stroke Severity Scale (C-STAT), Rapid Arterial oCclusion Evaluation (RACE) scale, and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) for prediction of LVO and stroke...
November 22, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29170268/leukoaraiosis-attenuates-diagnostic-accuracy-of-large-vessel-occlusion-scales
#15
Y Mayasi, R P Goddeau, M Moonis, B Silver, A H Jun-O'Connell, A S Puri, N Henninger
BACKGROUND AND PURPOSE: Prehospital stroke scales may help identify patients likely to have large-vessel occlusion to facilitate rapid triage to thrombectomy-capable stroke centers. Scale misclassification may result in inaccurate decisions and possible harm. Pre-existing leukoaraiosis has been shown to attenuate the association between deficit type and stroke severity. We sought to determine whether leukoaraiosis affects the predictive ability of 5 commonly used large-vessel occlusion scales...
November 23, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29169966/the-finnish-prehospital-stroke-scale-detects-thrombectomy-and-thrombolysis-candidates-a-propensity-score-matched-study
#16
Jyrki P Ollikainen, Heikki V Janhunen, Juho A Tynkkynen, Kalle M Mattila, Minna M Hälinen, Niku K Oksala, Satu-Liisa K Pauniaho
BACKGROUND: Prehospital stroke triage is challenged by endovascular treatment for large vessel occlusion (LVO) being available only in major stroke centers. Conjugate eye deviation (CED) is closely related to LVO, whereas common stroke signs (face-arm-leg-speech-visual) screen stroke. We hypothesized that combining CED with common stroke signs would yield a prehospital stroke scale for identifying both LVO and stroke in general. METHODS AND RESULTS: We retrospectively analyzed consecutive patients (n = 856) with prehospital Code Stroke (recanalization candidate)...
November 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29167387/prehospital-systolic-blood-pressure-is-related-to-intracerebral-hemorrhage-volume-on-admission
#17
David Rodriguez-Luna, Noelia Rodriguez-Villatoro, Jesús M Juega, Sandra Boned, Marián Muchada, Estela Sanjuan, Jorge Pagola, Marta Rubiera, Marc Ribo, Pilar Coscojuela, Carlos A Molina
BACKGROUND AND PURPOSE: Ultra-early blood pressure (BP) management in the prehospital setting could improve the efficacy of this treatment on attenuating intracerebral hemorrhage (ICH) expansion. We aimed to determine the association of prehospital systolic BP (SBP) with ICH volume, ultra-early hematoma growth, and the spot sign on admission. METHODS: We conducted a retrospective study of a prospective database of 219 consecutive patients with spontaneous ICH admitted to the emergency department of a tertiary stroke center during a 3-year period...
November 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29158105/the-effect-and-associated-factors-of-dispatcher-recognition-of-stroke-a-retrospective-observational-study
#18
Ming-Ju Hsieh, Kuo-Liong Chien, Jen-Tang Sun, Sung-Chun Tang, Li-Kai Tsai, Wen-Chu Chiang, Yu-Chun Chien, Jiann-Shing Jeng, Matthew Huei-Ming Ma
BACKGROUND/PURPOSE: Details of the communication between the caller and dispatcher have not been reported previously in Taiwan. This study aimed to: (1) understand the details of the communication between the caller and dispatcher among the calls for stroke patients, (2) identify factors associated with stroke recognition by dispatchers, and (3) evaluate the association between stroke recognition by dispatchers and stroke management. METHODS: We conducted a retrospective observational study involving patients with stroke or transient ischemic stroke transported by the emergency medical service, and arriving at 9 hospitals in Taipei within 3 h of symptom onset from January 1, 2013 to February 28, 2014...
November 17, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#19
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29127102/algorithms-to-guide-ambulance-clinicians-in-the-management-of-emergencies-in-patients-with-implanted-rotary-left-ventricular-assist-devices
#20
REVIEW
Christopher T Bowles, Rachel Hards, Neil Wrightson, Paul Lincoln, Shishir Kore, Laura Marley, Jonathan R Dalzell, Binu Raj, Tracey A Baker, Diane Goodwin, Petra Carroll, Jane Pateman, John J M Black, Paul Kattenhorn, Mark Faulkner, Jayan Parameshwar, Charles Butcher, Mark Mason, Alexander Rosenberg, Ian McGovern, Alexander Weymann, Carl Gwinnutt, Nicholas R Banner, Stephan Schueler, Andre R Simon, David W Pitcher
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making...
December 2017: Emergency Medicine Journal: EMJ
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