Trauma Communications Center Coordinated Severity-Based Stroke Triage: Protocol of a Hybrid Type 1 Effectiveness-Implementation Study.
Trauma Communications Center Coordinated Severity-Based Stroke Triage: Protocol of a Hybrid Type 1 Effectiveness-Implementation Study.
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DOI：
10.3389/fneur.2021.788273
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发表时间：
2021
影响因子：
3.4
通讯作者：
Kamal S
中科院分区：
文献类型：
--
作者：
Gropen TI;Ivankova NV;Beasley M;Hess EP;Mittman B;Gazi M;Minor M;Crawford W;Floyd AB;Varner GL;Lyerly MJ;Shoemaker CC;Owens J;Wilson K;Gray J;Kamal S
背景资料：机械血栓切除术（MT）可以改善大血管闭塞（LVO）患者的结局，但少数LVO患者接受了治疗，并且在及时获得MT方面存在差异。在某种程度上，这是因为在包括亚拉巴马在内的大多数地区，紧急医疗服务（EMS）将所有疑似中风的患者（无论严重程度如何）运送到最近的中风中心。因此，LVO患者可能延迟到达具有MT能力的卒中中心，结局更差。亚拉巴马的创伤通信中心（TCC）根据创伤严重程度和地区医院能力协调创伤患者的EMS运输。我们的目标是根据亚拉巴马的创伤系统开发一种基于严重程度的卒中分诊（SBST）护理模式，比较这种护理途径与亚拉巴马目前卒中分诊的有效性，以改善广泛、公平和及时获得MT的机会，并探讨利益相关者对干预的可行性、适当性和可接受性的看法。研究方法：这是一项混合1型有效性-实施研究，采用多阶段混合方法序贯设计和嵌入式观察性阶梯楔形簇试验。我们将把TCC指导的卒中严重程度评估扩展到亚拉巴马的所有EMS地区;进行利益相关者访谈和焦点小组，以帮助为疑似LVO患者制定地区和医院特定的院前和机构间卒中分诊计划;在亚拉巴马的六个EMS地区分阶段推出TCC协调SBST;并进行利益相关者调查和访谈，以评估干预的特定背景感知。主要结局是在实施TCC协调SBST前后，疑似LVO的院前卒中系统患者接受MT治疗的比例变化。次要结果包括实施前后广泛的公共卫生影响的变化，以及利益相关者对使用混合方法的干预措施的可行性、适当性和可接受性的看法。在36个月内总共观察了1200到1300次，我们有80%的把握度检测到主要终点改善15%。讨论内容：这个项目，如果成功的话，可以证明创伤系统的基础设施可以作为一个更综合和有效的中风急救系统的基础。
Background: Mechanical thrombectomy (MT) can improve the outcomes of patients with large vessel occlusion (LVO), but a minority of patients with LVO are treated and there are disparities in timely access to MT. In part, this is because in most regions, including Alabama, the emergency medical service (EMS) transports all patients with suspected stroke, regardless of severity, to the nearest stroke center. Consequently, patients with LVO may experience delayed arrival at stroke centers with MT capability and worse outcomes. Alabama's trauma communications center (TCC) coordinates EMS transport of trauma patients by trauma severity and regional hospital capability. Our aims are to develop a severity-based stroke triage (SBST) care model based on Alabama's trauma system, compare the effectiveness of this care pathway to current stroke triage in Alabama for improving broad, equitable, and timely access to MT, and explore stakeholder perceptions of the intervention's feasibility, appropriateness, and acceptability. Methods: This is a hybrid type 1 effectiveness-implementation study with a multi-phase mixed methods sequential design and an embedded observational stepped wedge cluster trial. We will extend TCC guided stroke severity assessment to all EMS regions in Alabama; conduct stakeholder interviews and focus groups to aid in development of region and hospital specific prehospital and inter-facility stroke triage plans for patients with suspected LVO; implement a phased rollout of TCC Coordinated SBST across Alabama's six EMS regions; and conduct stakeholder surveys and interviews to assess context-specific perceptions of the intervention. The primary outcome is the change in proportion of prehospital stroke system patients with suspected LVO who are treated with MT before and after implementation of TCC Coordinated SBST. Secondary outcomes include change in broad public health impact before and after implementation and stakeholder perceptions of the intervention's feasibility, appropriateness, and acceptability using a mixed methods approach. With 1200 to 1300 total observations over 36 months, we have 80% power to detect a 15% improvement in the primary endpoint. Discussion: This project, if successful, can demonstrate how the trauma system infrastructure can serve as the basis for a more integrated and effective system of emergency stroke care.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
9
作者：
Gabbe, Belinda J.;Simpson, Pam M.;Cameron, Peter A.
通讯作者：
Cameron, Peter A.
DOI：
10.1016/j.jstrokecerebrovasdis.2019.06.042
发表时间：
2019-09-01
影响因子：
2.5
作者：
Gropen, Toby, I;Gazi, Melissa;Acker, Joe
通讯作者：
Acker, Joe
影响因子：
105.7
作者：
Hawe, P;Shiell, A;Riley, T
通讯作者：
Riley, T
影响因子：
--
作者：
GOLDSTEIN, LB;BERTELS, C;DAVIS, JN
通讯作者：
DAVIS, JN