Centrally Guided Identification of Patients With Large Vessel Occlusion: Lessons From Trauma Systems
Centrally Guided Identification of Patients With Large Vessel Occlusion: Lessons From Trauma Systems
复制标题
DOI：
10.1016/j.jstrokecerebrovasdis.2019.06.042
复制
发表时间：
2019-09-01
影响因子：
2.5
通讯作者：
Acker, Joe
中科院分区：
文献类型：
--
作者：
Gropen, Toby, I;Gazi, Melissa;Acker, Joe
目的：通过使用基于创伤系统的紧急通信中心（ECC）指导紧急医疗服务（EMS），改善大血管闭塞（LVO）急性缺血性卒中患者的院前识别。方法：我们对24名ECC护理人员进行了紧急医学卒中评估（EMSA）培训。ECC引导EMS对疑似卒中患者进行EMSA。在研究的后半部分，我们在审查记录的ECC-EMS交互后向ECC提供了重点反馈。我们比较了ECC引导的EMSA与NIH卒中量表（NIHSS）预测LVO出院诊断的敏感性、特异性和受试者操作特征曲线下面积（AUC）以及95%置信区间。结果：我们从2016年9月至2018年2月招募了569例患者。在分析的463例患者中，236例（51%）出院诊断为卒中，227例（49%）为非卒中诊断。45例（19%）卒中患者伴LVO。对于预测LVO，EMSA AUC = 0.68（0.59 - 0.77）和NIHSS AUC = 0.73（0.65 - 0.81）之间无显著差异。EMSA评分大于或等于4的LVO敏感性= 75.6（60.5-87.1），特异性= 62.4（57.6-67.1）。在研究的前9个月，EMSA AUC = 0.61（0.44 - 0.77），而在后9个月，AUC = 0.74（0.64 - 0.84）。结论：ECC引导的院前EMSA是可行的，与NIHSS相比具有相似的预测LVO的能力，并且随着时间的推移具有持续的性能。
Objective: Improve prehospital identification of acute ischemic stroke patients with large vessel occlusion (LVO) by using a trauma system-based emergency communication center (ECC) to guide the emergency medical service (EMS). Methods: We trained 24 ECC paramedics in the Emergency Medical Stroke Assessment (EMSA). ECC-guided EMS in performance of the EMSA on patients with suspected stroke. During the second half of the study, we provided focused feedback to ECC after reviewing recorded ECC-EMS interactions. We compared the sensitivity, specificity, and area under the receiver operator characteristics curve (AUC) and 95% confidence interval of ECC-guided EMSA to the NIH Stroke Scale (NIHSS) for predicting a discharge diagnosis of LVO. Results: We enrolled 569 patients from September 2016 through February 2018. Of 463 patients analyzed, 236 (51%) had a discharge diagnosis of stroke and 227 (49%) had a nonstroke diagnosis. There were 45 (19%) stroke patients with LVO. For predicting LVO, there was no significant difference between the EMSA AUC = .68 (.59-.77) and the NIHSS AUC = .73 (.65-.81). An EMSA score greater than or equal to 4 had sensitivity = 75.6 (60.5-87.1) and specificity = 62.4 (57.6-67.1) for LVO. During the first 9 months of the study, the EMSA AUC = .61 (.44-.77) compared to an AUC = .74 (.64-.84) during the second 9 months. Conclusions: ECC-guided prehospital EMSA is feasible, has similar ability to predict LVO compared to the NIHSS, and has sustained performance over time.