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The Stockholm Strok...
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Keselman, BorisKarolinska Institutet
(author)
The Stockholm Stroke Triage Project : Outcomes of Endovascular Thrombectomy Before and After Triage Implementation
- Article/chapterEnglish2022
Publisher, publication year, extent ...
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Lippincott Williams & Wilkins,2022
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:oru-94718
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https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-94718URI
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https://doi.org/10.1161/STROKEAHA.121.034195DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:148603339URI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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Funding agencies:Soderberg FoundationsMedTechLabsInnovationsfonden
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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.
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Berglund, AnnikaKarolinska Institutet
(author)
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Ahmed, NiazKarolinska Institutet
(author)
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Bottai, MatteoKarolinska Institutet
(author)
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von Euler, Mia,1967-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Clinical Science and Education, Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden(Swepub:oru)mavr
(author)
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Holmin, StaffanKarolinska Institutet
(author)
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Laska, Ann-CharlotteKarolinska Institutet
(author)
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Mathé, Jan M.Karolinska Institutet
(author)
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Sjöstrand, ChristinaKarolinska Institutet
(author)
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Eriksson, Einar E.Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
(author)
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Mazya, Michael V.Karolinska Institutet
(author)
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Karolinska InstitutetInstitutionen för medicinska vetenskaper
(creator_code:org_t)
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In:Stroke: Lippincott Williams & Wilkins53:2, s. 473-4810039-24991524-4628
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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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Stroke
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Örebro University
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