Prehospital Stroke Triage: A Modeling Study on the Impact of Triage Tools in Different Regions

Direct transportation to a thrombectomy-capable intervention center is beneficial for patients with ischemic stroke due to large vessel occlusion (LVO), but can delay intravenous thrombolytics (IVT). The aim of this modeling study was to estimate the effect of prehospital triage strategies on treatm...

Full description

Saved in:
Bibliographic Details
Published in:Prehospital emergency care 2023-07, Vol.27 (5), p.630-638
Main Authors: Duvekot, Martijne H. C., Garcia, Bjarty L., Dekker, Luuk, Nguyen, Truc My, van den Wijngaard, Ido R., de Laat, Karlijn F., de Schryver, Els L. L. M., Kloos, Loet M. H., Aerden, Leo A. M., Zylicz, Stas A., Bosch, Jan, van Belle, Eduard, van Zwet, Erik W., Rozeman, Anouk D., Moudrous, Walid, Vermeij, Frédérique H., Lingsma, Hester F., Bakker, Jeannette, van Doormaal, Pieter Jan, van Es, Adriaan C. G. M., van der Lugt, Aad, Wermer, Marieke J. H., Dippel, Diederik W. J., Kerkhoff, Henk, Roozenbeek, Bob, Kruyt, Nyika D., Venema, Esmee
Format: Article
Language:English
Subjects:
Brain Ischemia - diagnosis
Emergency Medical Services
Fibrinolytic Agents - therapeutic use
Humans
Prospective Studies
Stroke - drug therapy
Stroke - therapy
Thrombolytic Therapy
Treatment Outcome
Triage
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Direct transportation to a thrombectomy-capable intervention center is beneficial for patients with ischemic stroke due to large vessel occlusion (LVO), but can delay intravenous thrombolytics (IVT). The aim of this modeling study was to estimate the effect of prehospital triage strategies on treatment delays and overtriage in different regions. We used data from two prospective cohort studies in the Netherlands: the Leiden Prehospital Stroke Study and the PRESTO study. We included stroke code patients within 6 h from symptom onset. We modeled outcomes of Rapid Arterial oCclusion Evaluation (RACE) scale triage and triage with a personalized decision tool, using drip-and-ship as reference. Main outcomes were overtriage (stroke code patients incorrectly triaged to an intervention center), reduced delay to endovascular thrombectomy (EVT), and delay to IVT. We included 1798 stroke code patients from four ambulance regions. Per region, overtriage ranged from 1-13% (RACE triage) and 3-15% (personalized tool). Reduction of delay to EVT varied by region between 24 ± 5 min (n = 6) to 78 ± 3 (n = 2), while IVT delay increased with 5 (n = 5) to 15 min (n = 21) for non-LVO patients. The personalized tool reduced delay to EVT for more patients (25 ± 4 min [n = 8] to 49 ± 13 [n = 5]), while delaying IVT with 3-14 min (8-24 patients). In region C, most EVT patients were treated faster (reduction of delay to EVT 31 ± 6 min (n = 35), with RACE triage and the personalized tool. In this modeling study, we showed that prehospital triage reduced time to EVT without disproportionate IVT delay, compared to a drip-and-ship strategy. The effect of triage strategies and the associated overtriage varied between regions. Implementation of prehospital triage should therefore be considered on a regional level.
ISSN:1090-3127
1545-0066
DOI:10.1080/10903127.2023.2215859