Dozois Adeline, Hampton Lorrie, Kingston Carlene W, Lambert Gwen, Porcelli Thomas J, Sorenson Denise, Templin Megan, VonCannon Shellie, Asimos Andrew W
From the Department of Emergency Medicine, Carolinas Medical Center, Carolinas Health System, Charlotte, NC (A.D., A.W.A.); CHS Northeast (L.H.), CHS Pineville (G.L.), and Center for Outcomes Research and Evaluation (M.T.), Carolinas Healthcare System, Charlotte, NC; Department of Neurology, Novant Health Presbyterian Medical Center, Charlotte, NC (C.W.K., D.S., S.V.C.); and Mecklenburg Emergency Medical Services Agency, Charlotte, NC (T.J.P.).
Stroke. 2017 Dec;48(12):3397-3399. doi: 10.1161/STROKEAHA.117.018925. Epub 2017 Oct 25.
The recently proposed American Heart Association/American Stroke Association EMS triage algorithm endorses routing patients with suspected large vessel occlusion (LVO) acute ischemic strokes directly to endovascular centers based on a stroke severity score. The predictive value of this algorithm for identifying LVO is dependent on the overall prevalence of LVO acute ischemic stroke in the EMS population screened for stroke, which has not been reported.
We performed a cross-sectional study of patients transported by our county's EMS agency who were dispatched as a possible stroke or had a primary impression of stroke by paramedics. We determined the prevalence of LVO by reviewing medical record imaging reports based on a priori specified criteria.
We enrolled 2402 patients, of whom 777 (32.3%) had an acute stroke-related diagnosis. Among 485 patients with acute ischemic stroke, 24.1% (n=117) had an LVO, which represented only 4.87% (95% confidence interval, 4.05%-5.81%) of the total EMS population screened for stroke.
Overall, the prevalence of LVO acute ischemic stroke in our EMS population screened for stroke was low. This is an important consideration for any EMS stroke severity-based triage protocol and should be considered in predicting the rates of overtriage to endovascular stroke centers.
美国心脏协会/美国卒中协会最近提出的紧急医疗服务（EMS）分诊算法支持根据卒中严重程度评分，将疑似大血管闭塞（LVO）急性缺血性卒中患者直接送往血管内治疗中心。该算法识别LVO的预测价值取决于在接受卒中筛查的EMS人群中LVO急性缺血性卒中的总体患病率，目前尚无相关报道。
我们对本县EMS机构运送的患者进行了一项横断面研究，这些患者被派诊为可能的卒中或急救人员的初步印象为卒中。我们根据预先指定的标准审查病历影像报告，以确定LVO的患病率。
我们纳入了2402例患者，其中777例（32.3%）有急性卒中相关诊断。在485例急性缺血性卒中患者中，24.1%（n = 117）有LVO，这仅占接受卒中筛查的EMS总人口的4.87%（95%置信区间，4.05% - 5.81%）。
总体而言，在我们接受卒中筛查的EMS人群中，LVO急性缺血性卒中的患病率较低。这是任何基于EMS卒中严重程度的分诊方案都应考虑的重要因素，并且在预测血管内卒中中心过度分诊率时也应予以考虑。
