Introduction/Purpose The outcomes of intra-arterial (IA) endovascular treatment in patients with large vessel occlusion (LVO) are time dependent. In order to identify emergency large vessel occlusion (ELVO) and notify the receiving hospital from the field, emergency medical services (EMS) in Ventura county of California use Ventura ELVO Scale (VES). Early notification of ELVO from the field can potentially shorten the door to needle and door to groin time by activation of Interventional Radiology (IR) team earlier and in future, it may help triage patients with stroke to comprehensive stroke center.
Methods and Analysis Ventura ELVO Scale (VES) comprise of four components: 1) Eye Deviation 2) Aphasia 3) Neglect 4) Obtundation, each component scoring either 1 or 0. The maximum score is 4 and minimum score is 0. The score of 1 or greater will be considered as ELVO positive. VES was implemented by EMS to identify ELVO patients in the catchment area of Los Robles Hospital and Medical Center (LRHMC). A positive ELVO score along with positive Cincinnati scale prompts ELVO activation. EMS then calls the neuro-interventionalist who activates the neuro-intervention protocol at LRHMC. Retrospective de-identified data was collected from EMS run sheets, emergency department (ED) and IR records of LRHMC for cases in which the stroke code was activated by EMS during the period of Jan 2016 to Jan 2017.
Result A total of 204 patients were activated as stroke code by Ventura county EMS, out of which 26 were activated as ELVO positive. The mean age of ELVO positive patients was 77 (SD ±13.01) with 11:15 male to female ratio. Large vessel occlusion (LVO) was confirmed in 18 out of 26 ELVO positive patients on subsequent angiogram. The mean door to IV t-pa time in ELVO positive patients with LVO was 23.20 mins (SD ±9.73) while the mean door to groin time was 73.20 mins (SD ±20.30). Mean door to reperfusion time was 135.20 mins (SD ±32.77). The sensitivity of VES was 94.74% while the specificity was 95.67%. The positive predictive value (PPV) was 69.23% while the negative predictive value (NPV) was 99.44%.
Conclusion VES demonstrated reliable sensitivity, specificity, PPV and NPV and its implementation achieved target door to needle and door to groin time in patients with LVO.
Disclosures M. Taqi: None. A. Sodhi: None. S. Suriya: None. S. Quadri: None. D. Shepherd: None. A. Salvucci: None. A. Stefansen: None.
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