Paramedic and Emergency Department Care of Stroke: Baseline Data From a Citywide Performance Improvement Study

2003 ◽  
Vol 12 (5) ◽  
pp. 411-417 ◽  
Author(s):  
Anne W. Wojner ◽  
Lewis Morgenstern ◽  
Andrei V. Alexandrov ◽  
Diana Rodriguez ◽  
David Persse ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Performance Improvement ◽  
Thrombolytic Treatment ◽  
Treatment Rate ◽  
Community Based ◽  
Transport Time ◽  
Emergency Department Care ◽  
Total Transport ◽  
Suspected Stroke

• Background Rapid diagnosis and transport by paramedics and efficient, effective emergency management are essential to improving care of acute stroke patients. • Objectives To measure the performance of paramedics and emergency departments providing care for patients with suspected acute stroke. • Methods Two stroke centers and 4 other hospitals where most patients with acute stroke in Houston, Tex, are admitted participated. Hospital and paramedic performance data were collected prospectively on 446 patients with suspected acute stroke transported by paramedics between September 1999 and February 2000. • Results Paramedics had a sensitivity of 66%, specificity of 98%, and overall accuracy of 72% in diagnosing stroke. For patients with suspected stroke, 58.5% arrived in the emergency department within 120 minutes of symptom onset; in confirmed cases, that percentage was 67%. Mean total transport time was 42.2 minutes and was significantly longer (P < .001) to inner-city hospitals (44 minutes) than to suburban, community-based centers (39 minutes). Door to computed tomography times were significantly (P < .001) shorter for the 2 stroke centers than the other hospitals. Overall thrombolysis treatment rate among patients with confirmed ischemic stroke was 7.4% (range, 0–19.4%); treatment rates at the 2 stroke centers were 5.9% and 19.4%. • Conclusions More than half of patients with suspected stroke arrive at hospitals while thrombolytic treatment is still feasible. Although the current rate for thrombolytic treatment in Houston exceeds the national rate, performance of paramedics and hospitals in treating acute stroke can be improved by increasing efficiency and standardizing medical practices.

scholarly journals Effect of region-wide use of prehospital stroke triage scale on management of patients with acute stroke

2021 ◽  
pp. neurintsurg-2021-017863
Author(s):  
Hayato Araki ◽  
Kazutaka Uchida ◽  
Shinichi Yoshimura ◽  
Kaoru Kurisu ◽  
Nobuaki Shime ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Success Rate ◽  
Preparation Time ◽  
Transport Time ◽  
Multicenter Cohort Study ◽  
Vessel Occlusion ◽  
Multicenter Cohort ◽  
Prehospital Management ◽  
Suspected Stroke ◽  
Time Of Intervention

BackgroundPrehospital stroke triage scales help with the decision to transport patients with suspected stroke to suitable hospitals.ObjectiveTo explore the effect of the region-wide use of the Japan Urgent Stroke Triage (JUST) score, which can predict several types of stroke: large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction other than LVO (CI).MethodsWe implemented the JUST score and conducted a retrospective and prospective multicenter cohort study at 13 centers in Hiroshima from April 1, 2018, to March 31, 2020. We investigated the success rate of the first request to the hospital, on-scene time, and transport time to hospital. We evaluated the door-to-puncture time, puncture-to-reperfusion time, and 90-day outcome among patients with final diagnoses of LVO.ResultsThe cohort included 5141 patients (2735 before and 2406 after JUST score implementation). Before JUST score implementation, 1269 strokes (46.4%) occurred, including 140 LVO (5.1%), 394 ICH (14.4%), 120 SAH (4.4%), and 615 CI (22.5%). The JUST score was used in 1484 (61.7%) of the 2406 patients after implementation, which included 1267 (52.7%) cases of stroke (186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%), and 567 CI (23.6%)). Success rate of the first request to the hospital significantly increased after JUST score implementation (76.3% vs 79.7%, p=0.004). JUST score implementation significantly shortened the door-to-puncture time (84 vs 73 min, p=0.03), but the prognosis remained unaltered among patients with acute LVO.ConclusionsUse of prehospital stroke triage scales improved prehospital management and preparation time of intervention among patients with acute stroke.

Abstract P182: Stroke Therapy in the Time of Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Paige Hargrove ◽  
Deborah Spann ◽  
Yvette Legendre ◽  
Ted Colligan ◽  
Sheryl Martin-Schild
Keyword(s):  
Stroke Volume ◽  
Acute Stroke ◽  
New Orleans ◽  
Thrombolytic Treatment ◽  
Stroke Therapy ◽  
Treatment Efficiency ◽  
Treatment Rate ◽  
Careful Evaluation ◽  
Stroke Registry ◽  
Acute Stroke Therapy

Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 and was centered on the Greater New Orleans Area. Louisiana is divided into 9 regions; New Orleans is in Region 1. A statewide survey indicated 100% of hospitals experienced a decline in stroke presentations. We sought to determine if treatment of stroke with intravenous (IV) thrombolytic declined or was delayed relative to pre-COVID-19. We also sought to evaluate a change in door in-door out (DIDO) for secondary transfers among patients who screened positive for large vessel occlusions (LVO). Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared stroke volume, treatment rate with IV thrombolytic, treatment efficiency, and DIDO in 2019 with March 2020 and Q2 2020. Results: Monthly stroke presentations declined by 20% starting March 2020 compared to the average monthly volume in 2019. The IV thrombolytic rate was down from 10.3% to 8.8% in Q2 2020. In Q2 2020, the median door-to-needle time was 12 minutes longer than it was during 2019 and the proportion with a documented reason for delay increased from 29.1 in 2019 to 33.3% in March 2020 and 37.5% in Q2 2020. The median DIDO increased by 13 minutes compared to 2019 (129 vs 116 minutes). Discussion: Louisiana experienced a reduction in stroke presentation following the initial surge of COVID-19 cases. The treatment rate and efficiency with IV thrombolytic declined and DIDO was prolonged among patients with suspected LVO. Careful evaluation of how the stroke code processes changed in response to COVID-19 may help to recover efficiency in delivering acute stroke therapy.

Abstract WP260: Imaging Appropriateness Criteria May Guide Effective Use of CT Angiography in Acute Stroke Workup

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christopher Goiney ◽  
Blake Carlson ◽  
Annemarie Relyea-Chew ◽  
Claire Creutzfeldt ◽  
Chun Yuan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Ct Angiography ◽  
Odds Ratio ◽  
Clinical Decision Making ◽  
Evidence Based ◽  
Positive Finding ◽  
Appropriateness Criteria ◽  
Presenting Symptoms ◽  
Suspected Stroke

Introduction: CT angiography (CTA) is a front-line imaging tool for the evaluation of acute stroke patients in the emergency department. In our experience, however, many CTAs performed for suspected stroke may not be appropriate and patients are found to have alternative diagnoses upon further work-up. We hypothesize that use of an evidence-based imaging guideline such as the American College of Radiology Appropriateness Criteria (ACR-AC) could facilitate more judicious use of CTA by identifying patients who are likely to have alternative diagnoses. Methods: We retrospectively reviewed patients who underwent CTA for stroke workup in the emergency department between January 2014 and January 2015. Patients evaluated for trauma, intracranial hemorrhage and known infarcts were excluded. Through PACS and EMR review, we identified 144 patients. Using a double-reader consensus method, we categorized each patient’s presenting symptoms based on the ACR-AC Neurologic Variants. Categories included: “usually appropriate,” “may be appropriate,” and “usually not appropriate”. We performed contingency table analyses using Fisher’s exact test and calculated odds ratios to correlate ACR-AC categories with CTA findings which explained stroke presentation such as arterial thrombosis, dissection, or high grade stenosis in a relevant vascular distribution. Results: Of the 144 patients who underwent CTA for stroke evaluation, 87 patients fell into the “usually appropriate” ACR-AC category, with 49 “may be appropriate” and 8 “usually not appropriate”. Within the first group, 19/87 CTAs were positive (21.8%) with an odds ratio of 4.98 (p=<0.01). In the second group, 3/49 CTAs were positive (6.1%) with an odds ratio of 0.26 (p=<0.03). In the third group, 0/8 CTAs were positive, with an odds ratio of 0.49 (p=0.61). Conclusion: Our data suggest that ACR-AC correlate with CTA findings relevant to stroke. Specifically, patients in the “usually appropriate” category were more likely to have a positive finding on CTA, while no positive CTAs were seen in the “usually not appropriate” category. These preliminary data suggest that the use of ACR-AC or similar criteria may aid clinical decision making and facilitate evidence-based use of CTA for suspected stroke workup.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

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