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Stroke prehospital

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https://www.readbyqxmd.com/read/28087807/field-validation-of-the-los-angeles-motor-scale-as-a-tool-for-paramedic-assessment-of-stroke-severity
#1
Joon-Tae Kim, Pil-Wook Chung, Sidney Starkman, Nerses Sanossian, Samuel J Stratton, Marc Eckstein, Frank D Pratt, Robin Conwit, David S Liebeskind, Latisha Sharma, Lucas Restrepo, May-Kim Tenser, Miguel Valdes-Sueiras, Jeffrey Gornbein, Scott Hamilton, Jeffrey L Saver
BACKGROUND AND PURPOSE: The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region. METHODS: We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals...
January 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28087804/clinical-selection-strategies-to-identify-ischemic-stroke-patients-with-large-anterior-vessel-occlusion-results-from-sits-istr-safe-implementation-of-thrombolysis-in-stroke-international-stroke-thrombolysis-registry
#2
Jan F Scheitz, Azmil H Abdul-Rahim, Rachael L MacIsaac, Charith Cooray, Heidi Sucharew, Dawn Kleindorfer, Pooja Khatri, Joseph P Broderick, Heinrich J Audebert, Niaz Ahmed, Nils Wahlgren, Matthias Endres, Christian H Nolte, Kennedy R Lees
BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. METHODS: Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012-May 2014) were analyzed retrospectively...
January 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27951536/glial-fibrillary-acidic-protein-for-prehospital-diagnosis-of-intracerebral-hemorrhage
#3
Michal Rozanski, Carolin Waldschmidt, Alexander Kunz, Ulrike Grittner, Martin Ebinger, Matthias Wendt, Benjamin Winter, Kerstin Bollweg, Kersten Villringer, Jochen B Fiebach, Heinrich J Audebert
BACKGROUND: Both, acute ischemic stroke (AIS) and hemorrhage stroke (intracerebral hemorrhage, ICH) require early attention but different treatment strategies. Plasma glial fibrillary acidic protein (GFAP) levels were found to be elevated in ICH patients after they arrived in the hospital. Because treatment options differed, we sought to determine whether GFAP can be used to accurately differentiate between of AIS and ICH in the prehospital setting. METHODS: We assessed acute stroke patients in the Stroke Emergency Mobile (STEMO)...
December 13, 2016: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/27894558/helicopter-scene-response-for-stroke-patients-a-5-year-experience
#4
Andrew Hawk, Catherine Marco, Matt Huang, Bonnie Chow
OBJECTIVE: The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. METHODS: CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27834751/stroke-thrombolysis-in-a-centralized-and-a-decentralized-system-helsinki-and-telemedical-project-for-integrative-stroke-care-network
#5
Gordian J Hubert, Atte Meretoja, Heinrich J Audebert, Turgut Tatlisumak, Florian Zeman, Sandra Boy, Roman L Haberl, Markku Kaste, Peter Müller-Barna
BACKGROUND AND PURPOSE: Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. METHODS: We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1...
November 10, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27827326/cutting-the-prehospital-on-scene-time-of-stroke-thrombolysis-in-helsinki-a-prospective-interventional-study
#6
Tuukka Puolakka, Markku Kuisma, Sami Länkimäki, Jyrki Puolakka, Juhana Hallikainen, Kirsi Rantanen, Perttu J Lindsberg
BACKGROUND AND PURPOSE: Significant portion of the prehospital delay consists of minutes spent on the scene with the patient. We implemented a training program for the emergency medical services personnel with the aim to optimize the on-scene time (OST) and to study the impact of different elements of prehospital practice to the OST duration. METHODS: In this prospective interventional study, key operational emergency medical service performance variables were analyzed from all thrombolysis candidates transported to the Helsinki University Hospital emergency department...
November 8, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27822599/prehospital-and-intra-hospital-time-delays-in-posterior-circulation-stroke-results-from-the-austrian-stroke-unit-registry
#7
Peter Sommer, Leonhard Seyfang, Alexandra Posekany, Julia Ferrari, Wilfried Lang, Elisabeth Fertl, Wolfgang Serles, Thomas Töll, Stefan Kiechl, Stefan Greisenegger
Therapeutic effect of recombinant tissue-plasminogen activator (rt-PA) is time dependent. There is limited evidence whether localization of stroke within the posterior circulation (PCS) is associated with a treatment delay. We aimed to analyze within a nationwide multicenter cohort whether duration of pre- and intra-hospital patient management differs between patients with PCS and anterior circulation strokes (ACS). We studied onset-to-door-times (ODT) and door-to-needle-times (DNT) of all patients with acute ischemic stroke (IS) enrolled in the Austrian Stroke Unit Registry according to infarct localization...
January 2017: Journal of Neurology
https://www.readbyqxmd.com/read/27818120/efficacy-and-safety-of-prehospital-administration-of-unfractionated-heparin-enoxaparin-or-bivalirudin-in-patients-undergoing-primary-percutaneous-coronary-intervention-for-st-segment-elevation-myocardial-infarction-insights-from-the-orbi-registry
#8
Vincent Auffret, Guillaume Leurent, Dominique Boulmier, Marc Bedossa, Amer Zabalawi, Jean-Philippe Hacot, Isabelle Coudert, Emmanuelle Filippi, Philippe Castellant, Antoine Rialan, Gilles Rouault, Philippe Druelles, Bertrand Boulanger, Josiane Treuil, Bertrand Avez, Marielle Le Guellec, Martine Gilard, Hervé Le Breton
BACKGROUND: Despite numerous studies in recent years, the best anticoagulant option for primary percutaneous coronary intervention (PCI) remains a matter of debate. AIMS: To compare in-hospital outcomes after prehospital administration of low-dose unfractionated heparin (UFH)±glycoprotein IIb/IIIa inhibitors (GPIs), enoxaparin±GPIs, or bivalirudin in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 1720 patients (median age 62...
December 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27814743/prehospital-fibrinolysis-versus-primary-percutaneous-coronary-intervention-in-st-elevation-myocardial-infarction-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#9
Vincent Roule, Pierre Ardouin, Katrien Blanchart, Adrien Lemaitre, Julien Wain-Hobson, Damien Legallois, Joachim Alexandre, Rémi Sabatier, Paul Milliez, Farzin Beygui
BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), but its benefit over prehospital fibrinolysis (FL) is not clear. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials in which outcomes of patients with STEMI managed with FL early in the prehospital setting versus PPCI were compared. RESULTS: Compared with PPCI, FL was consistently associated with similar rates of short-term (30-90 days) death (relative risk [RR] 0...
November 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27741992/treatment-of-acute-ischemic-stroke
#10
REVIEW
Matthew S Siket
Although stroke declined from the third to fifth most common cause of death in the United States, the annual incidence and overall prevalence continue to increase. Since the available US Food and Drug Administration-approved treatment options are time dependent, improving early stroke care may have more of a public health impact than any other phase of care. Timely and efficient stroke treatment should be a priority for emergency department and prehospital providers. This article discusses currently available and emerging treatment options in acute ischemic stroke focusing on the preservation of salvageable brain tissue, minimizing complications, and secondary prevention...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741991/diagnosis-of-acute-ischemic-stoke
#11
REVIEW
Lauren M Nentwich
Acute ischemic stroke is a challenging and time-sensitive diagnosis. Diagnosis begins with rapid detection of acute stroke symptoms by the patient, their family or caregivers, or bystanders. If acute stroke is suspected, EMS providers should be called for rapid assessment. EMS providers will utilize prehospital stroke tools to diagnose and determine potential stroke severity. Once at the hospital, the stroke team works rapidly to solidify the patient history, perform a focused neurologic examination and obtain necessary laboratory tests and brain imaging to accurately diagnose acute ischemic stroke and properly treat the patient...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27720525/predictive-value-of-modifications-of-the-prehospital-rapid-arterial-occlusion-evaluation-scale-for-large-vessel-occlusion-in-patients-with-acute-stroke
#12
David Carrera, Bruce C V Campbell, Jordi Cortés, Montse Gorchs, Marisol Querol, Xavier Jiménez, Mònica Millán, Antoni Dávalos, Natalia Pérez de la Ossa
BACKGROUND: Prehospital clinical scales to identify patients with acute stroke with a large vessel occlusion (LVO) and direct them to an endovascular-capable stroke center are needed. We evaluated whether simplification of the Rapid Arterial oCclusion Evaluation (RACE) scale, a 5-item scale previously validated in the field, could maintain its high performance to identify patients with LVO. METHODS: Using the original prospective validation cohort of the RACE scale, 7 simpler versions of the RACE scale were designed and retrospectively recalculated for each patient...
January 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27707873/prehospital-care-delivery-and-triage-of-stroke-with-emergent-large-vessel-occlusion-elvo-report-of-the-standards-and-guidelines-committee-of-the-society-of-neurointerventional-surgery
#13
G Lee Pride, Justin F Fraser, Rishi Gupta, Mark J Alberts, J Neal Rutledge, Ray Fowler, Sameer A Ansari, Todd Abruzzo, Barb Albani, Adam Arthur, Blaise Baxter, Ketan R Bulsara, Michael Chen, Josser E Delgado Almandoz, Chirag D Gandhi, Don Heck, Steven W Hetts, Joshua A Hirsch, M Shazam Hussain, Richard Klucznik, Seon-Kyu Lee, William J Mack, Thabele Leslie-Mazwi, Ryan A McTaggart, Philip M Meyers, J Mocco, Charles Prestigiacomo, Athos Patsalides, Peter Rasmussen, Robert M Starke, Peter Sunenshine, Donald Frei, Mahesh V Jayaraman
No abstract text is available yet for this article.
October 5, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27693052/prehospital-and-in-hospital-course-of-care-for-patients-with-acute-heart-failure-features-and-impact-on-prognosis-in-real-life
#14
Laura Cluzol, Jennifer Cautela, Pierre Michelet, Antoine Roch, François Kerbaul, Julien Mancini, Marc Laine, Michael Peyrol, Floriane Robin, Franck Paganelli, Laurent Bonello, Franck Thuny
BACKGROUND: Acute heart failure (AHF) is a life-threatening medical emergency for which no new effective therapies have emerged in recent decades. No previous study has exhaustively described the entire course of care of AHF patients from first medical contact to hospital discharge or assessed its impact on prognosis. AIM: To fully describe the course of care and analyze its influence on outcomes in patients hospitalized with an AHF syndrome in an academic university center...
September 29, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27679533/characteristics-and-outcomes-of-very-elderly-enrolled-in-a-prehospital-stroke-research-study
#15
Nerses Sanossian, Kathleen C Apibunyopas, David S Liebeskind, Sidney Starkman, Adrian M Burgos, Robin Conwit, Marc Eckstein, Frank Pratt, Sam Stratton, Scott Hamilton, Jeffrey L Saver
BACKGROUND AND PURPOSE: Greater numbers of individuals aged ≥80 years enjoy a high quality of life, yet historically stroke trials have excluded this population. We aimed to describe a population of very elderly successfully enrolled into an acute stroke trial and compare their characteristics and outcomes with the younger cohort. METHODS: We analyzed consecutive patients enrolled <2 hours of symptom onset in a prehospital stroke treatment trial, the FAST-MAG clinical trial (Field Administration of Stroke Therapy-Magnesium)...
November 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27642014/ultra-acute-diagnostics-for-stroke-large-scale-implementation-of-prehospital-biomarker-sampling
#16
O S Mattila, H Harve, S Pihlasviita, J Ritvonen, G Sibolt, M Pystynen, D Strbian, S Curtze, M Kuisma, T Tatlisumak, P J Lindsberg
OBJECTIVES: Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach. MATERIALS AND METHODS: Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique...
September 18, 2016: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/27608817/parental-care-seeking-behavior-and-prehospital-timelines-of-care-in-childhood-arterial-ischemic-stroke
#17
Mark T Mackay, Belinda Stojanovski, Ian Mosley, Leonid Churilov, Geoffrey A Donnan, Paul Monagle
BACKGROUND AND PURPOSE: Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. METHODS: A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014...
October 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27469579/analysis-of-the-new-code-stroke-protocol-in-asturias-after-one-year-experience-at-one-hospital
#18
C García-Cabo, L Benavente, J Martínez-Ramos, Á Pérez-Álvarez, A Trigo, S Calleja
INTRODUCTION: Prehospital code stroke (CS) systems have been proved effective for improving access to specialised medical care in acute stroke cases. They also improve the prognosis of this disease, which is one of the leading causes of death and disability in our setting. The aim of this study is to analyse results one year after implementation of the new code stroke protocol at one hospital in Asturias. PATIENTS AND METHODS: We prospectively included patients who were admitted to our tertiary care centre as per the code stroke protocol for the period of one year...
July 25, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/27411494/pre-hospital-delay-and-its-associated-factors-in-first-ever-stroke-registered-in-communities-from-three-cities-in-china
#19
Bin Jiang, Xiaojuan Ru, Haixin Sun, Hongmei Liu, Dongling Sun, Yunhai Liu, Jiuyi Huang, Li He, Wenzhi Wang
This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50-14.00) hours...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27377636/diagnosis-and-mortality-in-prehospital-emergency-patients-transported-to-hospital-a-population-based-and-registry-based-cohort-study
#20
Erika Frischknecht Christensen, Thomas Mulvad Larsen, Flemming Bøgh Jensen, Mette Dahl Bendtsen, Poul Anders Hansen, Søren Paaske Johnsen, Christian Fynbo Christiansen
OBJECTIVE: Knowledge about patients after calling for an ambulance is limited to subgroups, such as patients with cardiac arrest, myocardial infarction, trauma and stroke, while population-based studies including all diagnoses are few. We examined the diagnostic pattern and mortality among all patients brought to hospital by ambulance after emergency calls. DESIGN: Registry-based cohort study. SETTING AND PARTICIPANTS: We included patients brought to hospital in an ambulance dispatched after emergency calls during 2007-2014 in the North Denmark Region (580 000 inhabitants)...
2016: BMJ Open
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