Implementation of a Prehospital Stroke Triage System Using Symptom Severity and Teleconsultation in the Stockholm Stroke Triage Study

摘要

Question What was the predictive performance for large artery occlusion stroke and the association with onset-to-delivery times for endovascular and intravenous recanalization therapies during the first year following implementation of the prehospital Stockholm Stroke Triage System that combined motor symptom severity with ambulance-to-hospital teleconsultation? Findings In this cohort study of 2905 patients undergoing code-stroke ambulance transport within the Stockholm region (Sweden), the new triage system had an overall accuracy in predicting large-artery occlusion stroke of 87% (positive predictive value, 41%; negative predictive value, 93%). The median onset-to-puncture time for thrombectomy was 137 minutes vs 206 minutes in the previous year, while onset-to-needle time for intravenous thrombolysis was unchanged at a median of 115 minutes. Meaning Combining a symptom-based prehospital triage algorithm with ambulance-to-hospital teleconsultation may result in markedly reduced delivery times for thrombectomy without delaying intravenous thrombolysis.