Stefanie Behnke1, Thomas Schlechtriemen2, Andreas Binder3, Monika Bachhuber1, Mark Becker2, Benedikt Trauth1, Martin Lesmeister1, Elmar Spüntrup4, Silke Walter1, Lukas Hoor2, Andreas Ragoschke-Schumm1, Fatma Merzou1, Luca Tarantini1, Thomas Bertsch5, Jürgen Guldner6, Achim Magull-Seltenreich6, Frank Maier7, Christoph Massing7, Volkmar Fischer8, Michael Gawlitza9, Katrin Donnevert9, Hans-Michael Lamberty10, Stefan Jung11, Matthias Strittmatter12, Silke Tonner12, Johannes Schuler13, Robert Liszka13, Stefan Wagenpfeil14, Iris Q Grunwald15,16, Wolfgang Reith17, Klaus Fassbender18. 1. Department of Neurology, Saarland University Medical Center, Kirrberger St. Bldg. 90, 66421, Homburg, Germany. 2. Zweckverband für Rettungsdienst und Feuerwehralarmierung Saar, Bexbach, Germany. 3. Department of Neurology, Klinikum Saarbrücken, Saarbrücken, Germany. 4. Department of Radiology, Klinikum Saarbrücken, Saarbrücken, Germany. 5. Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany. 6. Department of Neurology, Knappschaftsklinikum Saar, Püttlingen, Germany. 7. Department of Neurology, Caritas-Klinikum Saarbrücken St. Theresia, Saarbrücken, Germany. 8. Department of Neurology, Diakonie Klinikum Neunkirchen, Neunkirchen/Saar, Germany. 9. Department of Neurology, Knappschaftsklinikum Saar, Sulzbach, Germany. 10. Department of Neurology, DRK Krankenhaus Saarlouis, Saarlouis, Germany. 11. Department of Neurology, Marienhaus Klinikum Saarlouis-Dillingen, Dillingen, Germany. 12. Department of Neurology, SHG Klinikum Merzig, Merzig, Germany. 13. Department of Neurology, Marienhaus Klinik St. Wendel, St. Wendel, Germany. 14. Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany. 15. Department of Neuroscience, Medical School, Anglia Ruskin University, Chelmsford, UK. 16. Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, UK. 17. Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany. 18. Department of Neurology, Saarland University Medical Center, Kirrberger St. Bldg. 90, 66421, Homburg, Germany. Klaus.Fassbender@uks.eu.
Abstract
BACKGROUND: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. METHODS: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. RESULTS: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%). CONCLUSIONS: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.
BACKGROUND: The prehospital identification of strokepatients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of strokepatients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. METHODS: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. RESULTS: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%). CONCLUSIONS: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.
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