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Eur J Neurol. 2018 Mar;25(3):425-433. doi: 10.1111/ene.13539. Epub 2018 Jan 12.

European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke.

Author information

1
Institute of Psychiatry and Neurology, Interventional Stroke and Cerebrovascular Diseases Treatment Centre, Warsaw, Poland.
2
Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
3
Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
4
Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
5
Division of Medical Sciences, Oxford University, Oxford, UK.
6
Department of Neurology, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
7
Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
8
Department of Neurology, Estonia Department of Neurology and Neurosurgery, Neurology Clinic, Tartu University Hospital, University of Tartu, Tartu, Estonia.
9
Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
10
Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK.
11
Department of Neurology, Oslo University Hospital, Oslo, Norway.
12
Department of Neurology, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.
13
Austrian Stroke Selfhelp Association, Lochau, Austria.
14
European Federation of Neurological Associations (EFNA) and Stroke Alliance for Europe (SAFE), Brussels, Belgium.
15
Department of Neurology, Centre for Neurosciences, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Erratum in

Abstract

BACKGROUND AND PURPOSE:

The reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting.

METHODS:

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations.

RESULTS:

Despite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a pre-hospital 'code stroke' including highest priority dispatch, pre-hospital notification and rapid transfer to the closest 'stroke-ready' centre. Insufficient evidence was found to recommend a pre-hospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for pre-hospital telemedicine during ambulance transport.

CONCLUSIONS:

These guidelines inform on the contemporary approach to patients with suspected stroke in the pre-hospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome.

KEYWORDS:

ambulance; pre-hospital care; stroke

PMID:
29218822
DOI:
10.1111/ene.13539
[Indexed for MEDLINE]

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