BACKGROUND: In 2005, a prehospital stroke screening tool was implemented in Toronto, Ontario, Canada. Patients identified by paramedics through the use of this tool in the field were transported to a regional stroke center under an acute stroke protocol. OBJECTIVE: To determine the positive predictive value (PPV) of the Ontario Prehospital Stroke Screening Tool for identification of acute stroke at a single stroke center. METHODS: We conducted a retrospective analysis of consecutive patients transported to a regional stroke center under the prehospital acute stroke protocol over a 12-month period. Final diagnoses, treatments, and outcomes were abstracted from a provincial registry. Rates of fibrinolysis were compared with those for the 12-month period prior to implementation of the stroke protocol. RESULTS: Three hundred twenty-five patients were triaged under the emergency medical services (EMS) acute stroke protocol over the study period. The PPV of the screening tool was 89.5% (95% confidence interval [CI]: 85.7-92.7%) for acute stroke. Thirty-four patients (11%) had nonstroke conditions, with the most common being seizure (4%). The rate of administration of tissue plasminogen activator (tPA) for all patients with suspected stroke increased from 5.9% to 10.1% (p = 0.04) compared with the rate in the 12-month period prior to implementation of the acute stroke protocol. The tPA rate for patients arriving under the stroke protocol was 17.2%. Most patients (75%) receiving tPA arrived from outside the hospital catchment area. CONCLUSIONS: In this preliminary study, the Ontario Prehospital Stroke Screening Tool had a high PPV for acute stroke and appeared to be effective for identifying patients who required triage to a single regional stroke center. Following implementation of a citywide acute stroke protocol using this screening tool, we observed an increase in the number of patients who were eligible for and received fibrinolysis at our stroke center.
BACKGROUND: In 2005, a prehospital stroke screening tool was implemented in Toronto, Ontario, Canada. Patients identified by paramedics through the use of this tool in the field were transported to a regional stroke center under an acute stroke protocol. OBJECTIVE: To determine the positive predictive value (PPV) of the Ontario Prehospital Stroke Screening Tool for identification of acute stroke at a single stroke center. METHODS: We conducted a retrospective analysis of consecutive patients transported to a regional stroke center under the prehospital acute stroke protocol over a 12-month period. Final diagnoses, treatments, and outcomes were abstracted from a provincial registry. Rates of fibrinolysis were compared with those for the 12-month period prior to implementation of the stroke protocol. RESULTS: Three hundred twenty-five patients were triaged under the emergency medical services (EMS) acute stroke protocol over the study period. The PPV of the screening tool was 89.5% (95% confidence interval [CI]: 85.7-92.7%) for acute stroke. Thirty-four patients (11%) had nonstroke conditions, with the most common being seizure (4%). The rate of administration of tissue plasminogen activator (tPA) for all patients with suspected stroke increased from 5.9% to 10.1% (p = 0.04) compared with the rate in the 12-month period prior to implementation of the acute stroke protocol. The tPA rate for patients arriving under the stroke protocol was 17.2%. Most patients (75%) receiving tPA arrived from outside the hospital catchment area. CONCLUSIONS: In this preliminary study, the Ontario Prehospital Stroke Screening Tool had a high PPV for acute stroke and appeared to be effective for identifying patients who required triage to a single regional stroke center. Following implementation of a citywide acute stroke protocol using this screening tool, we observed an increase in the number of patients who were eligible for and received fibrinolysis at our stroke center.
Authors: Christopher W Seymour; David Carlbom; Ruth A Engelberg; Jonathan Larsen; Eileen M Bulger; Michael K Copass; Thomas D Rea Journal: J Emerg Med Date: 2011-11-08 Impact factor: 1.484
Authors: Kristina Shkirkova; Samuel Schuberg; Emma Balouzian; Sidney Starkman; Marc Eckstein; Samuel Stratton; Franklin D Pratt; Scott Hamilton; Latisha Sharma; David S Liebeskind; Robin Conwit; Jeffrey L Saver; Nerses Sanossian Journal: Stroke Date: 2020-01-20 Impact factor: 7.914
Authors: Lisa E Thomas; Joshua N Goldstein; Reza Hakimelahi; Yuchiao Chang; Albert J Yoo; Lee H Schwamm; R Gilberto Gonzalez Journal: Int J Emerg Med Date: 2011-10-03
Authors: James P Sheppard; Ruth M Mellor; Sheila Greenfield; Jonathan Mant; Tom Quinn; David Sandler; Don Sims; Satinder Singh; Matthew Ward; Richard J McManus Journal: Emerg Med J Date: 2013-10-07 Impact factor: 2.740