Abstract 15: EMS In-Field Acute Stroke Severity Screening for Preferential Triage to a Comprehensive Stroke Center in Orlando, Florida
Background: The Brain Attack Coalition identified Comprehensive Stroke Centers (CSCs) to play a critical role in coordinating acute stroke care within a geographic region. Severe acute stroke patients may benefit from CSC specific interventions (neurosurgical or endovascular interventions) but are often transported to Primary Stroke Centers (PSC’s) lacking CSC specific interventions. A Critical determinant of the value of EMS preferential CSC triage with occasional bypass of PSC’s is the rate of utilization of CSC specific interventions among these patients.
Methods: We retrospectively evaluated combined data from two different EMS groups in two different counties using in-field modified versions of two different stroke severity scales designed to predict the presence of a large vessel occlusion: the 3 Item Stroke Scale (3I-SS) and the Los Angeles Motor Scale (LAMS). During the years 2007-2012 patients with the most severe suspected acute strokes were transported to a single CSC. We calculated the rate of utilization of CSC specific interventions and the length of stay based on in-field stroke severity scores.
Results: On average, this EMS preferential CSC triage policy resulted in a combined total of 12 more patients transported to the CSC each month by EMS from these two counties. Of the 526 patients preferentially CSC triaged 77 (15%) received a CSC specific intervention. The odds of receiving a CSC specific intervention were higher among patients with higher LAMS scores of 4-5 (30 of 143 patients) compared to those with scores of 1-3 (0 of 26 patients, Odds ratio =3.84, 95% CI =1.2-12.15). The mean length of stay was higher among patients with higher LAMS scores of 4 and 5 (8.2 days, 95% CI 7-9.4) compared to those with lower LAMS scores of 1-3 (4.3 days, 95% CI 3.2-5.4).
Conclusions: Our results support the ability of EMS to identify patients in-field with severe stroke-like symptoms that may require CSC specific intervention. PSC’s, CSC’s and EMS should collaboratively insure that these patients receive rapid evaluation for and prompt access to CSC specific interventions.
- © 2012 by American Heart Association, Inc.