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Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion
The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset. This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for mo...
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

In-Hospital Stroke
There have been tremendous strides in standardization of the care for acute ischemic stroke since widespread use of thrombolytic therapy began almost 20 years ago. Efficacy is still limited by delayed presentation to the emergency department following stroke symptom onset, although this has also improved in that period with education of emergency medical services and the community at large. The real improvement lies in development of streamlined and standardized protocols for “code stroke,” so that thrombolysis rates of 20% are becoming typical and door-to-needle times are just as typically under 1 hour. These encourag...
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research

Primary Stroke Centers vs Comprehensive Stroke Centers
During all but the last 5 years of the 20th century, life was rather simple for health care planners who were concerned with care for patients with stroke. There was no proven effective treatment; therefore, no special guidelines were required. Stroke care changed significantly in 1995, when intravenous (IV) tissue plasminogen activator (tPA) was found to be an effective treatment when given soon after stroke onset. With the intent of improving care, hospitals were encouraged to develop primary stroke centers (PSCs) that had sufficient medical personnel, technology, and protocols that would enable them to deliver IV tPA efficiently.
Source: JAMA Neurology - March 20, 2017 Category: Neurology Source Type: research

Prehospital Stroke Management Optimized by the Use of Clinical Scoring vs Mobile Stroke Unit
This randomized clinical trial explores how prehospital management optimized by the use of the Los Angeles Motor Scale compares with prehospital management in a mobile stroke unit that includes vascular imaging in accurately triaging patients with stroke to the appropriate target hospital providing (comprehensive stroke center) or not providing (primary stroke center) neurointerventional treatment.
Source: JAMA Neurology - September 3, 2019 Category: Neurology Source Type: research

Stroke Quality of Care in GWTG-Stroke Hospitals
This longitudinal cohort study compares quality of stroke care measures for patients admitted to hospitals participating and not participating in Get With The Guidelines –Stroke.
Source: JAMA Neurology - August 6, 2018 Category: Neurology Source Type: research

Remote Ischemic Perconditioning for the Treatment of Acute Ischemic Stroke —Reply
In Reply We thank Zhao et al for the interest in our randomized clinical trial. We agree that it is of interest to evaluate remote ischemic perconditioning specifically in patients with acute ischemic stroke and mismatch. We did not target these patients exclusively, because when the Remote Ischemic Conditioning in Acute Brain Infarction (RESCUE BRAIN) was designed in 2012, there was no proof of the efficacy of this approach; the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) and Endovascular Therapy Following Imaging Evaluati...
Source: JAMA Neurology - September 28, 2020 Category: Neurology Source Type: research

Care and Outcomes of Patients With In-Hospital Stroke
This prospective cohort study examines stroke care delivery and outcomes for patients with in-hospital vs community-onset stroke.
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research

Stroke Imaging
In this issue ofJAMA Neurology, Boulouis et al report on the crucial influence of pretreatment collateral blood vessel status in determining the benefit of transfer for endovascular thrombectomy for large vessel acute ischemic stroke. All patients had relatively little evidence of irreversible injury on noncontrast computed tomography (CT) at their referring hospitals. However, when imaging was repeated at the comprehensive stroke center, a substantial proportion of patients had evolved large infarcts that caused them not to proceed to endovascular therapy or foreshadowed a poor outcome. These data contribute to the weight...
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research

Clinical Care and In-Hospital Outcomes of Asian American Patients With Acute Ischemic Stroke
This analysis compares the characteristics, care, and outcomes of Asian American and white patients with acute ischemic stroke at hospitals participating in the Get With The Guidelines –Stroke program.
Source: JAMA Neurology - January 22, 2019 Category: Neurology Source Type: research

Quality Improvement Intervention for Hospital Adherence to Therapies for Patients With Stroke
This cluster randomized clinical trial assesses the effect of a multifaceted quality improvement intervention compared with routine care on adherence to evidence-based therapy among patients with acute ischemic stroke and transient ischemic attack.
Source: JAMA Neurology - May 6, 2019 Category: Neurology Source Type: research

External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke
This prognostic study evaluated medical records of survivors of ischemic stroke from a national Canadian database to develop and validate a scoring system to predict low-trauma fractures within 1 year of hospital discharge.
Source: JAMA Neurology - May 13, 2019 Category: Neurology Source Type: research

Effect of Remote Ischemic Perconditioning on Brain Infarct Growth in Patients With Ischemic Stroke
This randomized clinical trial examines whether in-hospital treatment with remote ischemic perconditioning that is administered within 6 hours of symptom onset, with or without reperfusion therapy, can reduce brain infarction volume growth in patients with acute ischemic stroke.
Source: JAMA Neurology - March 30, 2020 Category: Neurology Source Type: research

Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
This cohort study compares the rate of ischemic stroke among patients with COVID-19 vs patients with influenza in 2 hospitals in New York City, New York.
Source: JAMA Neurology - July 2, 2020 Category: Neurology Source Type: research

Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era
This cohort study uses a large US national registry to assess temporal trends from 2008 to 2018 in the use of intravenous and endovascular reperfusion therapies, process measures of quality, and association between functional outcomes and key patient characteristics, comorbidities, and treatments of in-hospital vs out-of-hospital stroke onset.
Source: JAMA Neurology - September 21, 2020 Category: Neurology Source Type: research

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity
This study describes differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity.
Source: JAMA Neurology - March 1, 2021 Category: Neurology Source Type: research

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