The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.

Eligibility and predictors for acute revascularization procedures in a stroke center. 1-800-AHA-USA-1

Pathway C: direct admission of clinically selected patients directly comprehensive stroke centers capable of EVT (termed the mother-ship approach) is likely to be quicker and therefore have more benefit for patients with LVOs, although this still needs to be proven.6 Also, the in-hospital delays in a streamlined one-stop imaging-to-thrombolysis-to-EVT procedure are likely less than the imaging-to-drip-and-ship approach. It confirms that several simple LVO scores (listed in Table 1) performed reasonably well for predicting LVO. *Preimaging opportunities where a clinical score may be used to identify EVT-eligible patients. A LAMS score of 4 or higher doubled, and a LAMS score of 0 to 3 halved, the likelihood that a patient was among the target group. The detailed methods of the FAST-MAG trial have been published previously.16,17 For this study, data were analyzed from consecutive patients transported to UCLA Medical Center, the only FAST-MAG receiving hospital site with a standing clinical policy throughout the study period (2004–2012) of obtaining vessel imaging immediately on patient arrival, using magnetic resonance angiography (MRA) or computed tomography angiography (CTA). Stroke-trained physicians without access to immediate arterial imaging can increase the precision of triage by using one of the more complex LVO scores such as the National Institute of Health Stroke Scale,11 the RACE (Rapid Arterial Occlusion Evaluation),14 or the ASTRAL-occlusion score12 (listed in Table 1). Large vessel occlusion scales increase delivery to endovascular centers without excessive harm from misclassifications. A considerable number of stroke scales for prehospital use have been published over recent years. The LAMS performs comparably or better than more extended prehospital scales and the full National Institutes of Health Stroke Scale. This study was supported by an Award from the National Institutes of Health (NIH-NINDS U01 NS 44364). Medical records of acute ischemic stroke patients within 24 h of stroke onset at Beijing Tiantan hospital were retrospectively collected. Notably in the current study, the LAMS performed prehospital by paramedics had higher sensitivity, though lower specificity, for LVO than the LAMS performed after arrival in the ED. The LAMS performed in the field by paramedics identifies LVO and CSC-appropriate patients with good accuracy. Table 3. The mode of first vessel imaging was MRA in 82% and CTA in 18%. This site uses cookies. Customer Service At the individual patient level, study entry criteria were (1) transport by UCLA Medical Center by emergency medical services (EMS) for likely stroke, (2) enrollment in FAST-MAG, and (3) MRA or CTA obtained within 6 hours of ED arrival and before intravenous tPA or endovascular thrombectomy.

Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. A FAST scale ≥2 showed sensitivity of 0.85209, specificity of 0.76301 and accuracy of 0.80518. This field validation study confirms and extends the findings of the initial derivation study of the LAMS for LVO recognition.6 Whereas the derivation study was based on patients examined by physicians in the ED, the current study confirms that the LAMS has value in identifying LVOs among all cerebral ischemia patients when actually performed by paramedics in the field, and also demonstrates scale value in identifying all CSC-appropriate patients (LVO AIS plus ICH) among all stroke transports. Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale. But again, pathway C requires important investments in the prehospital organization and EVT-capable centers willing to accept a significant rate of LVO overdiagnosis. CSC indicates Comprehensive Stroke Center; and LVO, large vessel occlusion. Global stroke guidelines and action plan: a road map for quality stroke care. Table 1. The 4 highest accuracy point estimates were for the LAMS (0.70), the C-STAT (0.68), the Prehospital Acute Stroke Severity scale (0.68), and the full NIHSS cutoff at ≥7 (0.68) and the 2 lowest point estimates were for the 3i-SS (0.62) and the VAN (0.63). In the current study, after ED arrival, the C-STAT showed comparable accuracy to the concurrently performed LAMS (0.68 versus 0.70). Stroke care: initial data from a county-based bypass protocol for patients with acute stroke. Methods Emergency medical services (EMS) personnel and stroke physicians (n=326) rated each item of the NIHSS … LVOs were present in 45/71 (63%), including XLVOs in 36/71 (51%), MVOs were present in 5/71 (7%), and no occlusion was observed in 21/71 (30%). A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions.

In the scale comparison portion of the current study, the predictive value of 8 scales performed by study nurse coordinators in the ED was assessed in identifying (1) LVOs among all patients with ACI and (2)CSC-appropriate patients among all suspected stroke patients. National Institutes of Health Stroke Scale score and vessel occlusion in 2152 patients with acute ischemic stroke. As a negative control, the predictive value of the prehospital GCS (PH GCS) administered by paramedics was also assessed. Overview of Several Scores Tested for LVO Prediction in AIS. Figure shows 3 typical pathways for suspected AIS patients in the 3-level care system that currently exists in many countries3 and was formalized recently by the World Stroke Organization.4 Using this map of acute stroke care, several important considerations come to light: Download figureDownload PowerPointFigure. Both the prehospital LAMS and ED NIHSS were higher in the target patients (Table 2; Figure 1A and 1B; Figure IA and IB in the online-only Data Supplement).

A positive LAMS (4 or higher) more than increases the likelihood a patient harbors a CSC-appropriate lesion by 2.5-fold and a negative LAMS reduces the likelihood by nearly two-thirds. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Design and validation of prehospital acute stroke triage (PAST) scale to predict large vessel occlusion, https://doi.org/10.1016/j.atherosclerosis.2020.04.001. Dallas, TX 75231 An acceptable rate of overdignosis could be 30% to 50% or somewhat less than half of all patients directed to an endovascular center, who would not fulfill treatment criteria after arterial imaging. https://doi.org/10.1161/STROKEAHA.117.019228, National Center Field validation of the Los Angeles Motor Scale as a tool for paramedic assessment of stroke severity. We undertook a field validation study of the LAMS for LVO recognition and for CSC-appropriate (LVO AIS and ICH patients) recognition, and analyzed the comparative performance of the LAMS with 6 other, later-proposed prehospital the full NIHSS. The performance of the LAMS, administered prehospital by paramedics to consecutive ambulance trial patients, was assessed in identifying (1) LVOs among all patients with ACI and (2) CSC-appropriate patients among all suspected strokes. Nonetheless, the current study findings are of direct value, as one-half of all EMS-transported ischemic stroke patients in the United States are encountered by paramedics within 2 hour of onset. Patients were placed in the category of CSC-appropriate if they had either LVO AIS or ICH. 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. Nonetheless, the current study findings are of direct value, as one-half of all EMS-transported ischemic stroke patients in the United States are encountered by paramedics within 2 hour of onset.38 The study sample size was moderate, and patients were transported by several ambulances from multiple EMS provider agencies, but within one geographic region to one receiving stroke center.

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