Pre-hospital Triage of Acute Ischemic Stroke Patients —Importance of Considering More Than Two Transport Options

Conclusion: Pre-hospital triage algorithms for AIS patients that only take into account the nearest CSC and the nearest PSC as transport destinations may be unable to identify the optimal transport destination for a significant proportion of patients. Introduction Background International guidelines recommend early administration of intravenous thrombolysis for eligible patients with acute ischemic stroke (AIS); in addition, patients with proximal large vessel occlusion (LVO) should receive mechanical thrombectomy (MT) as quickly as possible (1). As the clinical benefit of both thrombolysis (2–4) and MT (5–7) diminishes over time, research efforts in recent years have focused on improving clinical outcome by reducing pre-hospital (8–10) and intra-hospital delays (11, 12). With regard to pre-hospital delays, directly transporting AIS patients to an MT-capable comprehensive stroke center (CSC) instead of a nearer non-MT-capable primary stroke center (PSC) has been suggested as one strategy to reduce time to MT for patients with LVO (13). Given that information about the vessel status of patients is typically not available to emergency medical personnel in the field, patients that are likely to benefit from direct transportation to a CSC need to be selected based on clinical and demographic variables. Several clinical pre-hospital stroke severity scales with similar accuracies to estimate the likelihood of LVO exist (14); however, the optimal instr...
Source: Frontiers in Neurology - Category: Neurology Source Type: research