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Pre-hospital triage beneficial for suspected stroke

Saturday July 6, 2013
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Implementing an out-of hospital stroke policy in some Chicago hospitals was associated with significant improvements in emergency medical services use and increased intravenous tissue plasminogen activator use at primary stroke centers, according to a study.

The study, published July 1 on the website of JAMA Neurology, evaluated the relationship between 1) a citywide policy recommending pre-hospital triage of patients with suspected stroke to transport them to the nearest primary stroke center and 2) use of intravenous tPA use.

The study by Shyam Prabhakaran, MD, MS, of Northwestern University in Chicago, and colleagues included all admitted patients with stroke and transient ischemic attack at 10 primary stroke center hospitals in Chicago. The study was conducted from September 2010 through August 2011, spanning six months before and six months after the intervention began March 1, 2011.

There were 1,075 admissions for stroke and transient ischemic attack in the pre-triage periods and 1,172 admissions in the post-triage period. Compared with the pre-triage period, use of emergency medical services increased from 30.2% to 38.1%, and EMS pre-notification increased from 65.5% to 76.5% after implementation.

Rates of intravenous tPA use increased from 3.8% to 10.1%, and onset-to-treatment times decreased from 171.7 to 145.7 minutes from the pre-triage to the post-triage period, respectively.

“A citywide stroke system of care that includes a preferential triage policy and paramedic and public education can have a significant, immediate, sustainable impact on IV tPA use,” the authors concluded.

The Chicago Area Stroke Taskforce — consisting of healthcare professionals and other representatives — was formed in 2007 and developed criteria for pre-hospital triage of patients with suspected stroke to the nearest primary stroke center, the authors wrote.

Criteria include “symptom onset within six hours and abnormal Cincinnati Prehospital Stroke Scale score,” the authors wrote. “Additional relative criteria include markedly sudden alteration of consciousness, sudden-onset severe headache and sudden-onset of severe loss of balance. … If criteria were met, paramedics were advised to bypass [non-primary stroke centers] in favor of the closest PSC.”


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