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https://www.readbyqxmd.com/read/29781051/prehospital-prediction-of-large-vessel-occlusion-in-suspected-stroke-patients
#1
REVIEW
Kevin J Keenan, Charles Kircher, Jason T McMullan
PURPOSE OF REVIEW: Recent advances in endovascular thrombectomy have made acute ischemic stroke due to a large vessel occlusion more treatable than ever. Rapid access to treatment remains paramount and multiple large vessel occlusion prediction scales have been created to enhance prehospital identification and triage of these patients. This review summarizes the current state of large vessel occlusion prediction scales, proposes a set of ideal scale features, and discusses the future of these scales and prehospital neurological emergency response systems...
May 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29770601/prehospital-identification-of-factors-associated-with-death-during-one-year-follow-up-after-acute-stroke
#2
Per-Olof Hansson, Magnus Andersson Hagiwara, Peter Brink, Johan Herlitz, Birgitta Wireklint Sundström
OBJECTIVES: In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke. MATERIAL AND METHODS: All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1...
May 16, 2018: Brain and Behavior
https://www.readbyqxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#3
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759941/differences-in-and-determinants-of-prehospital-delay-times-among-stroke-patients-1994-versus-2012
#4
Angela Susan Labberton, Kashif Waqar Faiz, Ole Morten Rønning, Bente Thommessen, Mathias Barra
OBJECTIVES: Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades. METHODS: We compared time from symptom onset to admission in 2 cohorts of stroke patients admitted to Akershus University Hospital, Norway, in 1994 (n = 550) and 2012 (n = 522), and constructed predictive models for arrival within 3 hours for each cohort...
May 11, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29727304/the-frequency-characteristics-and-aetiology-of-stroke-mimic-presentations-a-narrative-review
#5
Graham McClelland, Helen Rodgers, Darren Flynn, Christopher I Price
A significant proportion of patients with acute stroke symptoms have an alternative 'mimic' diagnosis. A narrative review was carried out to explore the frequency, characteristics and aetiology of stroke mimics. Prehospital and thrombolysis-treated patients were described separately. Overall, 9972 studies were identified from the initial search and 79 studies were included with a median stroke mimic rate of 19% (range: 1-64%). The prehospital median was 27% (range: 4-43%) and the thrombolysis median 10% (range: 1-25%)...
May 1, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29719558/pomona-large-vessel-occlusion-screening-tool-for-prehospital-and-emergency-room-settings
#6
Kessarin Panichpisal, Kenneth Nugent, Maharaj Singh, Richard Rovin, Reji Babygirija, Yogesh Moradiya, Karen Tse-Chang, Kimberly A Jones, Katrina J Woolfolk, Debbie Keasler, Bhupat Desai, Parinda Sakdanaraseth, Paphavee Sakdanaraseth, Alimohammad Moalem, Nazli Janjua
Background: Early identification of patients with acute ischemic strokes due to large vessel occlusions (LVO) is critical. We propose a simple risk score model to predict LVO. Method: The proposed scale (Pomona Scale) ranges from 0 to 3 and includes 3 items: gaze deviation, expressive aphasia, and neglect. We reviewed a cohort of all acute stroke activation patients between February 2014 and January 2016. The predictive performance of the Pomona Scale was determined and compared with several National Institutes of Health Stroke Scale (NIHSS) cutoffs (≥4, ≥6, ≥8, and ≥10), the Los Angeles Motor Scale (LAMS), the Cincinnati Prehospital Stroke Severity (CPSS) scale, the Vision Aphasia and Neglect Scale (VAN), and the Prehospital Acute Stroke Severity Scale (PASS)...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29703777/prehospital-neurological-deterioration-in-stroke
#7
Sabreena J Slavin, Heidi Sucharew, Kathleen Alwell, Charles J Moomaw, Daniel Woo, Opeolu Adeoye, Matthew L Flaherty, Simona Ferioli, Jason McMullan, Jason Mackey, Felipe De Los Rios La Rosa, Sharyl Martini, Brett M Kissela, Dawn O Kleindorfer
BACKGROUND AND PURPOSE: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). METHODS: Among the Greater Cincinnati/Northern Kentucky region (population ~1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND...
April 27, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29685887/cardiopulmonary-resuscitation-in-infants-and-children-with-cardiac-disease-a-scientific-statement-from-the-american-heart-association
#8
REVIEW
Bradley S Marino, Sarah Tabbutt, Graeme MacLaren, Mary Fran Hazinski, Ian Adatia, Dianne L Atkins, Paul A Checchia, Allan DeCaen, Ericka L Fink, George M Hoffman, John L Jefferies, Monica Kleinman, Catherine D Krawczeski, Daniel J Licht, Duncan Macrae, Chitra Ravishankar, Ricardo A Samson, Ravi R Thiagarajan, Rune Toms, James Tweddell, Peter C Laussen
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms...
April 23, 2018: Circulation
https://www.readbyqxmd.com/read/29685471/the-age-of-undertriage-current-trauma-triage-criteria-underestimate-the-role-of-age-and-comorbidities-in-early-mortality
#9
Elizabeth R Benjamin, Desmond Khor, Jayun Cho, Subarna Biswas, Kenji Inaba, Demetrios Demetriades
BACKGROUND: National guidelines recommend that prehospital and emergency department (ED) criteria identify patients who might benefit from trauma center triage and highest-level trauma team activation. However, some patients who are seemingly "stable" in the field and do not meet the standard criteria for trauma activation still die. OBJECTIVES: The purpose of this study was to identify these at-risk patients to potentially improve triage algorithms. METHODS: Patients enrolled in the National Trauma Data Bank (2007-2012) were included...
April 19, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29618372/prehospital-triage-of-patients-diagnosed-with-perforated-peptic-ulcer-or-peptic-ulcer-bleeding-an-observational-study-of-patients-calling-1-1-2
#10
Kasper Bonnesen, Kristian D Friesgaard, Morten T Boetker, Lone Nikolajsen
BACKGROUND: Triage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB)...
April 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29602617/association-between-delirium-and-prehospitalization-medication-in-poststroke-patients
#11
Ryuichiro Hosoya, Yohei Sato, Emika Ishida, Haruna Shibamoto, Seiichi Hino, Hiroaki Yokote, Tomoyuki Kamata
PURPOSE: Medication is an important risk factor for delirium; however, the association between delirium and prehospitalization medication is unclear. We investigated the association between prestroke medication and poststroke delirium. MATERIALS AND METHODS: All patients hospitalized in the stroke care unit from September 2011 to September 2012 were selected, and their delirium symptoms, patient information, and pre- and poststroke medications were analyzed. Delirium was defined as a score of  4 or higher on the Intensive Care Delirium Screening Checklist...
March 27, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29596006/accuracy-of-prehospital-identification-of-stroke-in-a-large-stroke-belt-municipality
#12
Nee-Kofi Mould-Millman, Halea Meese, Ibthial Alattas, Moges Ido, Iasson Yi, Tolulope Oyewumi, Michael Colman, Michael Frankel, Arthur Yancey
OBJECTIVE: Strokes are a leading cause of morbidity and mortality in the United States, especially in the "stroke belt" of the southeast. Up to 65% of stroke patients access care by calling 9-1-1. The primary objective of this study is to measure the accuracy of emergency medical dispatchers (EMD) and paramedics, in the prehospital identification of stroke. METHODS: The study was based at Grady Emergency Medical Services, which is Atlanta, Georgia's public emergency medical services (EMS) provider...
March 29, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29581351/correction-to-effects-of-prehospital-thrombolysis-in-stroke-patients-with-prestroke-dependency
#13
(no author information available yet)
No abstract text is available yet for this article.
April 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29545057/intravenous-recombinant-tissue-plasminogen-activator-and-ischemic-stroke-focused-update-of-2010-clinical-practice-advisory-from-the-american-academy-of-emergency-medicine
#14
William J Meurer, Bradley Barth, Michael Abraham, Jerome R Hoffman, Gary M Vilke, Gerard DeMers
BACKGROUND: Stroke treatment is a continuum that begins with the rapid identification of symptoms and treatment with transition to successful rehabilitation. Therapies for acute ischemic stroke (AIS) may vary based on anatomic location, interval from symptom onset, and coexisting health conditions. Successful therapy requires a seamless systematic approach with coordination from prehospital environment through acute management at medical facilities to disposition and long-term care of the patient...
May 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29543140/imaging-selection-for-acute-stroke-intervention
#15
Bruce Cv Campbell, Mark W Parsons
This review summarizes the current state of knowledge regarding the use of imaging to guide stroke treatment. Brain imaging plays a central role in the diagnosis of stroke and identification of the mechanism of stroke, which is relevant to acute treatment, prognosis, and secondary prevention. The chief potential modalities are computed tomography (CT) and magnetic resonance imaging (MRI). Currently, most imaging occurs in hospital but mobile stroke units have expanded CT brain imaging into the prehospital field...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29540611/ambulance-clinical-triage-for-acute-stroke-treatment-paramedic-triage-algorithm-for-large-vessel-occlusion
#16
Henry Zhao, Lauren Pesavento, Skye Coote, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, Leonid Churilov, Nawaf Yassi, Stephen M Davis, Bruce C V Campbell
BACKGROUND AND PURPOSE: Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. METHODS: The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen...
April 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29539602/stroke-referrals-from-nursing-homes-high-rate-of-mimics-and-late-presentation
#17
Markus Kneihsl, Christian Enzinger, Kurt Niederkorn, Gerit Wünsch, Lisa Müller, Valeriu Culea, Andreas Lueger, Franz Fazekas, Thomas Gattringer
BACKGROUND: Stroke has become a treatable condition with increasing evidence of treatment benefits in older people. However, stroke mimics in geriatric patients are especially prevalent, causing incorrect suspicion and consecutive burden to patients and emergency room resources. We therefore examined the dimension of this problem by investigating emergency room admissions from nursing homes for suspected stroke. METHODS: We performed a retrospective cohort study of all nursing home residents who were admitted to the neurological emergency room of our primary and tertiary care university hospital between 2013 and 2015...
2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29490898/prehospital-advanced-diagnostics-and-treatment-of-acute-stroke-protocol-for-a-controlled-intervention-study
#18
Kristi G Bache, Maren Ranhoff Hov, Karianne Larsen, Volker Moræus Solyga, Christian G Lund
BACKGROUND: Acute ischemic stroke (AIS) is a medical emergency. The outcome is closely linked to the time elapsing from symptom onset to treatment, and seemingly small delays can mean the difference between full recovery and physical and cognitive dysfunction. Recanalization to allow blood to reenter the affected area is most efficient immediately after symptoms occur, and intravenous thrombolysis must be initiated no later than 4.5 hours after the symptom onset. A liable diagnosis is mandatory to administer the appropriate treatment...
February 28, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29459395/effects-of-prehospital-thrombolysis-in-stroke-patients-with-prestroke-dependency
#19
COMPARATIVE STUDY
Christian H Nolte, Martin Ebinger, Jan F Scheitz, Alexander Kunz, Hebun Erdur, Frederik Geisler, Tim-Bastian Braemswig, Michal Rozanski, Joachim E Weber, Matthias Wendt, Katja Zieschang, Jochen B Fiebach, Kersten Villringer, Ulrike Grittner, Sabina Kaczmarek, Matthias Endres, Heinrich J Audebert
BACKGROUND AND PURPOSE: Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily -independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency...
March 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29459391/los-angeles-motor-scale-to-identify-large-vessel-occlusion-prehospital-validation-and-comparison-with-other-screens
#20
RANDOMIZED CONTROLLED TRIAL
Ali Reza Noorian, Nerses Sanossian, Kristina Shkirkova, David S Liebeskind, Marc Eckstein, Samuel J Stratton, Franklin D Pratt, Robin Conwit, Fiona Chatfield, Latisha K Sharma, Lucas Restrepo, Miguel Valdes-Sueiras, May Kim-Tenser, Sidney Starkman, Jeffrey L Saver
BACKGROUND AND PURPOSE: Prehospital scales have been developed to identify patients with acute cerebral ischemia (ACI) because of large vessel occlusion (LVO) for direct routing to Comprehensive Stroke Centers (CSCs), but few have been validated in the prehospital setting, and their impact on routing of patients with intracranial hemorrhage has not been delineated. The purpose of this study was to validate the Los Angeles Motor Scale (LAMS) for LVO and CSC-appropriate (LVO ACI and intracranial hemorrhage patients) recognition and compare the LAMS to other scales...
March 2018: Stroke; a Journal of Cerebral Circulation
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