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- W2914793562 abstract "Introduction: There is need for sustainable models of effective prehospital stroke triage. Goal: Prospectively validate communication center guided prehospital identification of stroke patients with large vessel occlusion (LVO). Methods: We trained Alabama Trauma Communication Center (ATCC) paramedics in the previously derived 6 point Emergency Medical Stroke Assessment (EMSA). ATCC staff guided Emergency Medical Service (EMS) responders in the Birmingham Regional Emergency Medical Services System (BREMSS), and paged-out a hospital prenotification that included specific EMSA items (gaze, facial droop, arm drift, leg drift, naming, and repetition). Ongoing quality improvement was designed to enable the ATCC staff to effectively guide EMS responders. We derived the sensitivity, specificity, negative likelihood ratio (LR-), positive likelihood ratio (LR+), and receiver operator characteristics area under the curve (AUC) and 95% confidence intervals (CI) of ATCC guided EMSA for predicting a discharge diagnosis of LVO for patients transported to the University of Alabama at Birmingham. Results: We enrolled 521 patients from September 2016 through February 2018. Patients who only responded to pain (n=29, 5.6%) or who were unresponsive (n=21, 4%) were excluded. Of 471 patients analyzed, 247(52%) had a discharge diagnosis of stroke, including 182 (74%) acute ischemic stroke, 36 (14%) intracerebral hemorrhage, and 29 (11%) transient ischemic attack. There were 45 (18%) stroke patients with proximal LVO, including 31 middle cerebral artery stem, 12 internal carotid artery, and 2 basilar artery. Overall, an EMSA score ≥ 4 had sensitivity = 75.6%, specificity = 62.2%, LR- = 0.39, and LR+ = 2.00 for proximal LVO. During the first 9 months of the study, the EMSA AUC = 0.61 (CI = 0.45 – 0.77) compared to an AUC = 0.74 (CI = 0.64 – 0.84) during the second 9 month period of the study. Conclusions: EMS stroke medical control based on communication center guided prehospital stroke assessment and ongoing quality improvement is feasible and results in sustained ability to identify patients with LVO. Further studies are needed to evaluate the impact of guided prehospital triage of patients with suspected LVO on health outcomes." @default.
- W2914793562 created "2019-02-21" @default.
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- W2914793562 date "2019-02-01" @default.
- W2914793562 modified "2023-09-26" @default.
- W2914793562 title "Abstract TP313: Communication Center Guided Prehospital Stroke Assessment Has Sustained Ability to Identify Patients With Large Vessel Occlusion" @default.
- W2914793562 doi "https://doi.org/10.1161/str.50.suppl_1.tp313" @default.
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