Florida International University Herbert Wertheim College of Medicine, Miami, FL USA.
Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL USA.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105220. doi: 10.1016/j.jstrokecerebrovasdis.2020.105220. Epub 2020 Aug 13.
Acute stroke outcomes depend on timely reperfusion. In 3/2017, local EMS agencies implemented a prehospital triage algorithm with hospital bypass and field activation of the neurointerventional team using the Field Assessment Stroke Triage for Emergency Destination (FAST-ED). A score ≥4 bypasses to a comprehensive stroke center (CSC) and a score ≥6 also has the interventional team field activated off-hours.
We analyzed effects of this initiative on volume, acute stroke transfers, treatment times, and outcomes and determined the tool's ability to predict large vessel occlusion.
Stroke cases brought to our center by EMS during 3/2016-2/2018 were analyzed, which included one year before and after FAST-ED implementation. Treatment times were compared on- vs. off-hours and to those with field activation.
Of 1153 patients, 761 (67%) were coded as stroke and 235 (20%) underwent reperfusion. Age, sex, race/ethnicity, stroke severity, length of stay, door-to-needle, and 90-d mRS were comparable between periods. Scale compliance was 85%. Concordance rate of ±1 between EMS and calculated score was 53%. Compared to the previous year, door-to-puncture (DTP) improved by 17 min (p < 0.01) overall, 25 min (p < 0.001) off-hours, and 33 min (p < 0.05) with field activation. A cutoff of 4 vs. 6 would have led to 140% increase in field activations but only 36% increase in procedures.
This prehospital initiative led to faster DTP by up to 33 min. The highest impact was off-hours with field activation. Only 1/3 of activations led to endovascular treatment. FAST-ED≥6 appears to be appropriate for field activation.
急性脑卒中的治疗效果取决于及时的再灌注。2017 年 3 月，当地的 EMS 机构实施了一种院前分诊算法，通过医院旁路和使用现场评估卒中分诊以确定急诊目的地（FAST-ED）来激活神经介入团队。评分≥4 分则将患者转运至综合性卒中中心（CSC），评分≥6 分且患者在非工作时间发病时也会激活介入团队进行现场治疗。
分析该方案对工作量、急性脑卒中转运、治疗时间和结果的影响，并确定该工具预测大血管闭塞的能力。
分析了 2016 年 3 月至 2018 年 2 月期间通过 EMS 转运至我院的脑卒中患者，包括 FAST-ED 实施前后各一年的病例。比较了工作时间与非工作时间以及与现场激活的治疗时间。
在 1153 例患者中，761 例（67%）被编码为脑卒中，235 例（20%）接受了再灌注治疗。两个时间段的患者年龄、性别、种族/民族、卒中严重程度、住院时间、门到针时间和 90 天 mRS 评分均相似。该量表的符合率为 85%。EMS 和计算评分之间的±1 一致性率为 53%。与前一年相比，总体上 DTP 时间缩短了 17 分钟（p<0.01），非工作时间缩短了 25 分钟（p<0.001），现场激活时缩短了 33 分钟（p<0.05）。将截断值设为 4 分与 6 分相比，现场激活的比例将增加 140%，但治疗比例仅增加 36%。
该院前方案使 DTP 时间缩短了 33 分钟，尤其是在非工作时间并进行现场激活的情况下。只有 1/3 的激活病例进行了血管内治疗。FAST-ED≥6 似乎适用于现场激活。
