Personalized Prehospital Triage in Acute Ischemic Stroke

• DOI: 10.1161/strokeaha.118.022562
• Publication Date: 2019-01-21T10:10:29Z
• Authors: Esmee Venema; Hester F. Lingsma; Vicky Chalos; Maxim J.H.L. Mulder; Maarten M.H. Lahr; Aad van der Lugt; Adriaan C.G.M. va...; Ewout W. Steyerberg; M.G. Myriam Hunink; Diederik W.J. Dippel; Bob Roozenbeek
• Keywords: Triage; Stroke; Groin

Background and Purpose- Direct transportation to a center with facilities for endovascular treatment might be beneficial patients acute ischemic stroke, but it can also cause harm by delay of intravenous treatment. Our aim was determine the optimal prehospital strategy individual assess which factors influence this decision. Methods- We constructed decision tree model compare outcome stroke after primary versus more distant intervention center. The estimated based on patient characteristics, geographic location, workflow times. In base case scenario, located at 20 minutes 45 minutes. Additional sensitivity analyses included an urban scenario (10 minutes) rural (30 90 minutes). Results- led better outcomes in when likelihood large vessel occlusion as >33%. With high (66%, comparable Rapid Arterial Occlusion Evaluation score 5 or above), benefit direct 0.10 quality-adjusted life years (=36 days full health). risk 24% higher. threshold 49%. Other influencing door-to-needle times, door-to-groin door-in-door-out time. Conclusions- preferred suspected depends mainly occlusion, driving in-hospital robust that combines these characteristics used personalize triage, especially remote areas.