Abstract 89: Accuracy and Clinical Implications of Cincinnati Pre-hospital Stroke Scale and Los Angeles Pre-hospital Stroke Scale use by Emergency Medical Services

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tushar Trivedi ◽  
Khosrow Heidari ◽  
Anwar Merchant ◽  
Ed Jauch ◽  
Swamy Venkatesh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Los Angeles ◽  
Emergency Medical Services ◽  
Hospital Discharge ◽  
Predictive Value ◽  
False Negative ◽  
True Positive ◽  
Emergency Medical ◽  
Hospital Discharge Records ◽  
Iv Tpa

Background: Cincinnati Pre-hospital Stroke Scale (CPSS) and Los Angeles Pre-hospital Stroke Scale (LAPSS) are widely used by emergency medical services (EMS) to screen potential ischemic stroke patients. We performed a population based state-wide study to evaluate the accuracy of CPSS and LAPSS in identifying stroke cases and investigate their impact on ischemic stroke treatment. Methods: A statewide EMS database was created by linking South Carolina’s statewide Emergency Department (ED) and hospital discharge records for the calendar years 2010-2012. The EMS data were obtained from the Division of EMS and Trauma at Department of Health Environmental Control and linked to hospitalization records at Office of Research and Statistics. Results from the EMS use of CPSS and LAPSS were compared with hospital discharge diagnoses for stroke. For both scales, we calculated Sensitivity, Specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Additionally we evaluated the impact of identification of stroke during EMS transportation by CPSS/LAPSS on treatment of ischemic stroke with intravenous tissue plasminogen activator (IV-tPA). Results: Of all the EMS transported cases between January 2010 and December 2012, use of CPSS or LAPSS was recorded for 101,442 cases. Among the cases where the use of CPSS/LAPSS stroke scale was recorded, 6,757 cases had a diagnosis of ischemic stroke on hospital discharge records. CPSS demonstrated sensitivity of 59%, and specificity of 96%. Sensitivity and specificity for LAPSS were 26% and 84%, respectively. PPV and NPV for CPSS were 45% and 98%, and for LAPSS were 27% and 83%, respectively. Rates of IV-tPA administration were approximately five times higher for those correctly identified by CPSS (18.3% for true positive vs. 3.5% for false negative, P<0.01), and about two higher for those correctly identified by LAPSS (33.3% for true positive vs. 14.9% for false negative, P<0.01). Conclusion: Early identification of potential stroke cases using CPSS/LAPSS can have a significant impact on treatment of ischemic stroke with IV-tPA. We report a modest accuracy of CPSS and LAPSS in correctly identifying stroke cases in the field, with CPSS leading to a better rate of IV-tPA use compared with LAPSS.

scholarly journals Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 1013-1016 ◽  
Author(s):  
Hong-Qiu Gu ◽  
Zhen-Zhen Rao ◽  
Xin Yang ◽  
Chun-Juan Wang ◽  
Xing-Quan Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Emergency Medical Services ◽  
Chinese Patients ◽  
Tissue Type ◽  
Medical Services ◽  
Stroke Severity ◽  
Emergency Medical ◽  
Early Arrival ◽  
Timely Treatment ◽  
Iv Tpa

Background and Purpose— Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods— We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates’ balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results— Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95–2.20] for onset-to-door time ≤2 hours, 2.32 [2.18–2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88–3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62–1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70–1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions— Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.

Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

2018 ◽  
Vol 14 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Kumar Mukherjee ◽  
Khalid M Kamal
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Significant Risk ◽  
Primary Diagnosis ◽  
Inpatient Cost ◽  
Targeted Interventions ◽  
Hospital Discharge Records ◽  
Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

Abstract W MP75: Increase Usage of Acute Stroke Thrombolysis Leads to Better Outcome: The Emergency Medical Service-Discharge Diagnosis Data Linkage Analysis over Three Years

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Amanda Cotter ◽  
Khosrow Heidari ◽  
Michelle Androulakis ◽  
Andrea Griffin ◽  
Karen Cartrett ◽  
...  
Keyword(s):  
South Carolina ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Real Time ◽  
Hospital Discharge ◽  
Data Linkage ◽  
Discharge Diagnosis ◽  
Number Of Patients ◽  
Hospital Discharge Records ◽  
Stroke Thrombolysis

Background and Objective: South Carolina is located in the “buckle” of the stoke belt. Use of the emergency medical services (EMS), intravenous tissue plasminogen activator (IV t-PA) in acute stroke and its correlates, including outcomes have not been trended over time. To study the annual trends in the above acute stroke care parameters we linked the EMS database with the statewide hospital discharge records stored at South Carolina Department of Health and Environmental Control (SC DHEC). Methods: The ongoing statewide EMS database linkage with the hospital discharge records stored at SC DHEC, allow us to track EMS and acute stroke thrombolysis in real-time. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, stroke center status of the hospital, telemedicine usage and treatment with IV t-PA for the calendar years of 2010-2012. Results: In the calendar years of 2010-2012, 10,377; 10,532 and 10,900 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke respectively. Of these, the number of patients transported by EMS that received IV t-PA (7.1%, 9.5% and 10.2%, in the years 2010-12; χ2 trend =15.3, p < 0.0001) shows a significant increasing linear trend over the number of patients that were not transported by EMS that received IV t-PA (2.5%, 3.6% and 3.7%, in the years 2010-12). Over the three years, patients that are treated with IV t-PA were more likely to be discharged home (39%, 42% and 49% in the years 2010-12 ) and less likely to be discharged to a healthcare institution or expire (61%, 58% and 51% in the years 2010-12; χ2 trend=9.3, p =0.002). Conclusion: Transportation by EMS increased the likelihood of receiving IV t-PA. Over three years, IV t-PA usage led to better outcome including increasing discharge to home, decreasing discharge to healthcare institution and death. The real-time data linkage methodology may allow us in future to test the impact of statewide interventions geared to promote the usage of EMS and IV t-PA.

scholarly journals Value Utilization of Emergency Medical Services Air Transport in Acute Ischemic Stroke

2020 ◽  
Vol 59 (5) ◽  
pp. 687-692
Author(s):  
Amelia K. Adcock ◽  
Joseph Minardi ◽  
Scott Findley ◽  
Deb Daniels ◽  
Michelle Large ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Air Transport ◽  
Medical Services ◽  
Emergency Medical

Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain

2019 ◽  
Vol 41 (06) ◽  
pp. 688-694
Author(s):  
Ron Bardin ◽  
Noga Perl ◽  
Reuven Mashiach ◽  
Eitan Ram ◽  
Sharon Orbach-Zinger ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
False Positive ◽  
Acute Abdominal Pain ◽  
Cohort Analysis ◽  
False Negative ◽  
True Positive ◽  
Adnexal Torsion ◽  
Positive Group

Abstract Purpose To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. Materials and Methods Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. Results The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). Conclusion Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.

scholarly journals Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers

2019 ◽  
Author(s):  
Yanfeng Zhou ◽  
Shijiao Yan ◽  
Xingyue Song ◽  
Yanhong Gong ◽  
Wenzhen Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Best Practice ◽  
Hubei Province ◽  
Medical Services ◽  
Multivariable Logistic Regression Model ◽  
Stroke Treatment ◽  
Early Admission ◽  
Emergency Medical

Abstract Background: Rates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists’ experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists. Methods: Survey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists’ experiences with thrombolysis. Results: Of the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR]=5.81, 95% confidence intervals [CI] 3.31-10.20), using emergency medical services to be hospitalized (OR=3.36, 95% CI 2.00-5.62), stroke history (OR=0.53, 95% CI 0.28-0.99), and National Institute of Health Stroke Scale score < 4 (OR=0.46, 95% CI 0.27-0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR=2.84, 95% CI 1.84-4.37), education level (OR=2.49, 95% CI 1.09-5.73), and working years (OR=1.88, 95% CI 1.18-3.00) were strongly associated with neurologists’ experiences of thrombolysis. Conclusions: A very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families. Keywords: Thrombolysis; stroke; neurologists; emergency medical services; China; Risk factor.

Abstract 206: Pre-notification by Emergency Medical Services is Associated with More Timely Evaluation and Treatment of Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Cheryl Lin ◽  
Eric D Peterson ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
Li Liang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Get With The Guidelines

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent. Emergency medical services (EMS) pre-notification of stroke arrivals may provide a means of reducing evaluation and treatment times. In this study we used data from the nationwide Get With The Guidelines Stroke (GWTG-Stroke) program to determine the effect of EMS pre-notification on acute ischemic stroke processes of care. Methods: Acute ischemic stroke patients transported by EMS to 1585 GWTG-Stroke hospitals from April 2003 to March 2011 were studied. The association between EMS pre-notification and door-to-imaging (DTI) times, door-to-needle (DTN) times, onset-to-needle times (OTN), and tPA treatment rates were analyzed using multivariable GEE regression analyses. Results: Of 371,988 EMS transported acute ischemic stroke patients, EMS pre-notification occurred in 249,197 (67.0%). Patients with pre-notification had shorter door-to-imaging times, shorter onset-to-needle times, and were more likely to be treated with tPA when eligible ( Table ). EMS pre-notification was independently associated with increased odds of DTI ≤25 minutes (adjusted OR 1.53, 95% CI 1.44–1.63, p<0.0001), DTN times ≤60 minutes (aOR 1.20, 95% CI 1.10–1.31, p<0.0001), OTN times (aOR 1.17, 95% CI 1.09–1.25, p<0.0001), and tPA use within 3 hours among eligible patients arriving by 2 hours (aOR 1.64, 95% CI 1.50–1.79, p<0.0001), without significant increases in complications of thrombolytic therapy. Conclusion: EMS pre-notification is independently associated with more rapid patient imaging and increased timeliness in IV tPA administration. These results support the need for initiatives targeted at increasing EMS pre-notification rates as a mechanism from improving quality of care and outcomes in acute ischemic stroke.

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