PLUMBER Study (Prevalence of Large Vessel Occlusion Strokes in Mecklenburg County Emergency Response)
PLUMBER Study (Prevalence of Large Vessel Occlusion Strokes in Mecklenburg County Emergency Response)
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DOI：
10.1161/strokeaha.117.018925
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发表时间：
2017-12-01
期刊：
影响因子：
8.3
通讯作者：
Asimos, Andrew W.
中科院分区：
文献类型：
--
作者：
Dozois, Adeline;Hampton, Lorrie;Asimos, Andrew W.
背景和目的——最近提出的美国心脏协会/美国中风协会 EMS 分诊算法支持根据中风严重程度评分将疑似大血管闭塞 (LVO) 急性缺血性中风的患者直接送往血管内中心。该算法识别 LVO 的预测价值取决于中风筛查 EMS 人群中 LVO 急性缺血性中风的总体患病率，但尚未有报道。 方法 - 我们对本县 EMS 机构转运的患者进行了一项横断面研究，这些患者被视为可能中风或被护理人员初步印象为中风。我们根据先验指定标准审查病历影像报告来确定 LVO 的患病率。结果 - 我们招募了 2402 名患者，其中 777 名 (32.3%) 患有急性中风相关诊断。在 485 名急性缺血性卒中患者中，24.1% (n=117) 患有 LVO，仅占卒中筛查的 EMS 人群总数的 4.87%（95% 置信区间，4.05%-5.81%）。结论 - 总体而言，在我们筛查卒中的 EMS 人群中，LVO 急性缺血性卒中的患病率较低。对于任何基于 EMS 卒中严重程度的分诊方案来说，这是一个重要的考虑因素，并且在预测血管内卒中中心的过度分诊率时应予以考虑。
Background and Purpose-The recently proposed American Heart Association/American Stroke Association EMS triage algorithm endorses routing patients with suspected large vessel occlusion (LVO) acute ischemic strokes directly to endovascular centers based on a stroke severity score. The predictive value of this algorithm for identifying LVO is dependent on the overall prevalence of LVO acute ischemic stroke in the EMS population screened for stroke, which has not been reported.Methods-We performed a cross-sectional study of patients transported by our county's EMS agency who were dispatched as a possible stroke or had a primary impression of stroke by paramedics. We determined the prevalence of LVO by reviewing medical record imaging reports based on a priori specified criteria.Results-We enrolled 2402 patients, of whom 777 (32.3%) had an acute stroke-related diagnosis. Among 485 patients with acute ischemic stroke, 24.1% (n=117) had an LVO, which represented only 4.87% (95% confidence interval, 4.05%-5.81%) of the total EMS population screened for stroke.Conclusions-Overall, the prevalence of LVO acute ischemic stroke in our EMS population screened for stroke was low. This is an important consideration for any EMS stroke severity-based triage protocol and should be considered in predicting the rates of overtriage to endovascular stroke centers.