Enhancing Stroke Prehospital and Emergency Evaluation and Delivery (E-SPEED)

在美国，每年有近80万人受到中风的影响，中风仍然是头号杀手 成人致残原因和第五大死因。尽管全国范围内的中风中心激增， 获得及时的中风护理和循证治疗的机会仍然很少，效率低下， 导致医疗服务碎片化的冗余、错误和基于系统的障碍。一种中风护理系统 整合和协调非卒中中心医院、初级卒中中心和 建议建立综合性中风中心，因为它将使中风相关死亡人数减少2万人 每年在美国和全球近40万人。这项提议意义重大，因为它解决了两个问题 关于卒中患者急性评估和治疗的重要知识空白：院前 医院间转院中的筛查错误和延误。加强卒中院前急救 评估和交付(E-SPEED)研究将(1)增强现有的LVO筛查工具，评估 机器学习方法改进了LVO预测，并评估了增强的LVO的影响 院前环境中的筛查工具；以及(2)使用学习协作和模拟来设计， 实施并试点测试新的医院间卒中转移协议。我们将系统工程师聚集在一起 和中风健康服务研究人员在一项新的合作中，将产生可推广的知识， 可广泛应用于全国其他城市地区，并提供初步数据和示范 可以在跨多个领域的大规模比较有效性研究中进行评估的新方法 地区。

Nearly 800,000 people in the United States (US) each year are affected by stroke, which remains the leading cause of adult disability and 5th leading cause of death. Despite the proliferation of stroke centers nationwide, access to timely stroke care and evidence-based therapies is still poor with multiple inefficiencies, redundancies, errors, and system-based barriers that lead to care fragmentation. A stroke system of care that integrates and coordinates care between non-stroke center hospitals, primary stroke centers, and comprehensive stroke centers has been recommended since it would reduce stroke-related deaths by 20,000 annually in the US and nearly 400,000 worldwide. This proposal is significant because it addresses two important gaps in knowledge about the acute evaluation and treatment of stroke patients: prehospital screening errors and delays in inter-hospital transfer. The Enhancing Stroke Prehospital and Emergency Evaluation and Delivery (E-SPEED) study will (1) enhance existing LVO screening tools, assess whether machine learning approaches improve LVO prediction, and evaluate the impact of an Enhanced LVO Screening Tool in the prehospital setting; and (2) use learning collaboratives and simulations to design, implement, and pilot test a new inter-hospital stroke transfer protocol. We bring together systems engineers and stroke health service researchers in a novel collaboration that will produce generalizable knowledge that can be widely applied to other urban regions of the country and provide preliminary data and demonstration of novel approaches that could be evaluated in large-scale comparative effectiveness studies across multiple regions.