Severe hemiparesis as a prehospital tool to triage stroke severity: a pilot study to assess diagnostic accuracy and treatment times.
BACKGROUND
With the publication of the recent trials showing the tremendous benefits of mechanical thrombectomy, opportunities exist to refine prehospital processes to identify patients with larger stroke syndromes.


METHODS
We retrospectively reviewed consecutive patients who were brought via scene flight from rural parts of the region to our institution, from December 1, 2014 to June 5, 2015, with severe hemiparesis or hemiplegia. We assessed the accuracy of the diagnosis of stroke and the number of patients requiring endovascular therapy. Moreover, we reviewed the times along the pathway of patients who were treated with endovascular therapy.


RESULTS
45 patients were brought via helicopter from the field to our institution. 27 (60%) patients were diagnosed with an ischemic stroke. Of these, 12 (26.7%) were treated with mechanical thrombectomy and 6 (13.3%) with intravenous tissue plasminogen activator alone. An additional three patients required embolization procedures for either a dural arteriovenous fistula or cerebral aneurysm. Thus a total of 15 (33%) patients received an endovascular procedure and 21/45 (46.7%) received an acute treatment. For patients treated with thrombectomy, the median time from first medical contact to groin puncture was 101 min, with 8 of the 12 patients (66.7%) being discharged to home.


CONCLUSIONS
We have presented a pilot study showing that severe hemiparesis or hemiplegia may be a reasonable prehospital tool in recognizing patients requiring endovascular treatment. Patients being identified earlier may be treated faster and potentially improve outcomes. Further prospective controlled studies are required to assess the impact on outcomes and cost effectiveness using this methodology.
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Rishi
R
Gupta
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Marissa
M
Manuel
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Kumiko
K
Owada
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Samish
S
Dhungana
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Leslie
L
Busby
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Brenda A
BA
Glenn
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Debbie
D
Brown
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Susan A
SA
Zimmermann
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Christopher
C
Horn
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Dustin
D
Rochestie
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Joseph T
JT
Hormes
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Andrew K
AK
Johnson
Wellstar Neurosciences Network, Wellstar Health System, Kennestone Hospital, Marietta, Georgia, USA.
Ahmad
A
Khaldi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D002545:Brain Ischemia / Q000150:complications; D020785:Central Nervous System Vascular Malformations / Q000601:surgery / Q000628:therapy; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000175:diagnosis*; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*; D017131:Thrombectomy; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*
D010959:Tissue Plasminogen Activator
Stroke; Thrombectomy