RT Journal Article
SR Electronic
T1 Stroke care: initial data from a county-based bypass protocol for patients with acute stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 631
OP 635
DO 10.1136/neurintsurg-2016-012476
VO 9
IS 7
A1 Syed F Zaidi
A1 Julie Shawver
A1 Aixa Espinosa Morales
A1 Hisham Salahuddin
A1 Gretchen Tietjen
A1 David Lindstrom
A1 Brent Parquette
A1 Andrea Adams
A1 Andrea Korsnack
A1 Mouhammad A Jumaa
YR 2017
UL http://jnis.bmj.com/content/9/7/631.abstract
AB Background Early identification and transfer of patients with acute stroke to a primary or comprehensive stroke center results in favorable outcomes.Objective To describe implementation and results of an emergency medical service (EMS)-driven stroke protocol in Lucas County, Ohio.Method All county EMS personnel (N=464) underwent training in the Rapid Arterial oCclusion Evaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke and a RACE score ≥5 were taken to a facility that offered advanced therapy, was implemented in July 2015. During the 6-month study period, 109 RAs were activated. Time efficiencies, diagnostic accuracy, and mechanical thrombectomy (MT) outcomes were compared with standard ‘stroke-alert’ (N=142) patients from the preceding 6 months.Results An increased treatment rate (25.6% vs 12.6%, p<0.05) and improved time efficiency (median door-to-CT 10 vs 28 min, p<0.05; door-to-needle 46 vs 75 min, p<0.05) of IV tissue plasminogen activator within the RA cohort was achieved. The rate of MT (20.1% vs 7.7%, p=0.06) increased and treatment times improved, including median arrival-to-puncture (68 vs 128 min, p=0.04) and arrival-to-recanalization times (101 vs 205 min, p=0.001) in favor of the RA cohort. A non-significant trend towards improved outcome (50% vs 36.4%, p=0.3) in the RA cohort was noted. The RA protocol also showed improved diagnostic specificity for ischemic stroke (52.3% vs 30.1%, p<0.05).Conclusions Our results indicate that EMS adaptation of the RA protocol within Lucas County is feasible and effective for early triage and treatment of patients with stroke. Using this protocol, we can significantly improve treatment times for both systemic thrombolysis and MT.