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The Stockholm Strok...
The Stockholm Stroke Triage Project : Outcomes of Endovascular Thrombectomy Before and After Triage Implementation
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- Keselman, Boris (author)
- Karolinska Institutet
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- Berglund, Annika (author)
- Karolinska Institutet
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- Ahmed, Niaz (author)
- Karolinska Institutet
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- Bottai, Matteo (author)
- Karolinska Institutet
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- von Euler, Mia, 1967- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,Department of Clinical Science and Education, Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
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- Holmin, Staffan (author)
- Karolinska Institutet
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- Laska, Ann-Charlotte (author)
- Karolinska Institutet
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- Mathé, Jan M. (author)
- Karolinska Institutet
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- Sjöstrand, Christina (author)
- Karolinska Institutet
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- Eriksson, Einar E. (author)
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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- Mazya, Michael V. (author)
- Karolinska Institutet
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(creator_code:org_t)
- Lippincott Williams & Wilkins, 2022
- 2022
- English.
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In: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 53:2, s. 473-481
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- BACKGROUND AND PURPOSE: The Stockholm Stroke Triage System (SSTS) is a prehospital algorithm for detection of endovascular thrombectomy (EVT)-eligible patients, combining symptom severity assessment and ambulance-to-hospital teleconsultation, leading to a decision on primary stroke center bypass. In the Stockholm Region (6 primary stroke centers, 1 EVT center), SSTS implementation in October 2017 reduced onset-to-EVT time by 69 minutes. We compared clinical outcomes before and after implementation of SSTS in an observational study.METHODS: We prospectively recruited patients transported by Code Stroke ambulance within the Stockholm region under the SSTS, treated with EVT during October 2017 to October 2019, and compared to EVT patients from 2 previous years.OUTCOMES: shift in modified Rankin Scale (mRS) scores, mRS score 0 to 1, mRS score 0 to 2, and death (all 3 months), National Institutes of Health Stroke Scale (NIHSS) score change 24-hour post-EVT, recanalization (Thrombolysis in Cerebral Infarction 2b-3), and symptomatic intracranial hemorrhage. mRS outcomes were adjusted for age and baseline NIHSS.RESULTS: Patients with EVT in the SSTS group (n=244) were older and had higher baseline NIHSS versus historical controls (n=187): median age 74 (interquartile range, 63-81) versus 71 (61-78); NIHSS score 17 (11.5-21) versus 15 (10-20). During SSTS, median onset-to-puncture time was 136 versus 205 minutes (P<0.001). Adjusted common odds ratio for lower mRS in SSTS patients was 1.7 (95% CI, 1.2-2.3) versus controls. During SSTS, 83/240 (34.6%) versus 44/186 (23.7%) reached 3-month mRS score 0 to 1 (P=0.014), adjusted common odds ratio 2.3 (95% CI, 1.4-3.6). Median NIHSS change 24-hour post-EVT was 6 versus 4 (P=0.005). Differences in Thrombolysis in Cerebral Infarction, symptomatic intracranial hemorrhage, and death were nonsignificant.CONCLUSIONS: With an onset to arterial puncture time reduction by 69 minutes, outcomes in thrombectomy-treated patients improved significantly after region-wide large artery occlusion triage system implementation. These results warrant replication studies in other geographic and organizational circumstances.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Keyword
- Cohort studies
- emergency medical services
- stroke
- thrombectomy
- thrombolytic therapy
- time-to-treatment
- triage
Publication and Content Type
- ref (subject category)
- art (subject category)
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Stroke
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- By the author/editor
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Keselman, Boris
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Berglund, Annika
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Ahmed, Niaz
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Bottai, Matteo
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von Euler, Mia, ...
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Holmin, Staffan
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Laska, Ann-Charl ...
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Mathé, Jan M.
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Sjöstrand, Chris ...
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Eriksson, Einar ...
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Mazya, Michael V ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Neurology
- Articles in the publication
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Stroke
- By the university
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Örebro University
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Karolinska Institutet