Format

Send to

Choose Destination
J Neurointerv Surg. 2017 Jul;9(7):631-635. doi: 10.1136/neurintsurg-2016-012476. Epub 2016 Jun 24.

Stroke care: initial data from a county-based bypass protocol for patients with acute stroke.

Author information

1
Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
2
Promedica Toledo Hospital, Toledo, Ohio, USA.
3
Lucas County EMS, Toledo, Ohio, USA.
4
Mercy St Vincent Hospital Toledo, Toledo, Ohio, USA.

Abstract

BACKGROUND:

Early identification and transfer of patients with acute stroke to a primary or comprehensive stroke center results in favorable outcomes.

OBJECTIVE:

To describe implementation and results of an emergency medical service (EMS)-driven stroke protocol in Lucas County, Ohio.

METHOD:

All county EMS personnel (N=464) underwent training in the Rapid Arterial oCclusion Evaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke and a RACE score ≥5 were taken to a facility that offered advanced therapy, was implemented in July 2015. During the 6-month study period, 109 RAs were activated. Time efficiencies, diagnostic accuracy, and mechanical thrombectomy (MT) outcomes were compared with standard 'stroke-alert' (N=142) patients from the preceding 6 months.

RESULTS:

An increased treatment rate (25.6% vs 12.6%, p<0.05) and improved time efficiency (median door-to-CT 10 vs 28 min, p<0.05; door-to-needle 46 vs 75 min, p<0.05) of IV tissue plasminogen activator within the RA cohort was achieved. The rate of MT (20.1% vs 7.7%, p=0.06) increased and treatment times improved, including median arrival-to-puncture (68 vs 128 min, p=0.04) and arrival-to-recanalization times (101 vs 205 min, p=0.001) in favor of the RA cohort. A non-significant trend towards improved outcome (50% vs 36.4%, p=0.3) in the RA cohort was noted. The RA protocol also showed improved diagnostic specificity for ischemic stroke (52.3% vs 30.1%, p<0.05).

CONCLUSIONS:

Our results indicate that EMS adaptation of the RA protocol within Lucas County is feasible and effective for early triage and treatment of patients with stroke. Using this protocol, we can significantly improve treatment times for both systemic thrombolysis and MT.

KEYWORDS:

Standards; Stroke

PMID:
27342763
PMCID:
PMC5520240
DOI:
10.1136/neurintsurg-2016-012476
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center