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innovation
resources
urgent care

Advanced prehospital stroke triage in the era of mechanical thrombectomy

02 April 2019
Features
02 April 2019
Volume 11 · Issue 4

Abstract

Direct transport to a comprehensive stroke centre that is capable of endovascular thrombectomy may improve outcomes in patients with large vessel occlusive stroke. A number of prehospital triage tools have been developed to see if clinicians can predict which patients would benefit from this procedure, allowing them to bypass a primary stroke centre in preference for a comprehensive stroke centre. A literature search was performed across a number of medical databases; six triage tools were selected for analysis based on their reported accuracy and prevalence in clinical trials. Additionally, a number of articles were isolated for the analysis of changing systems of care for patients who had had a stroke. This narrative review integrates how these variously accurate triage tools could benefit patients and outlines why changes to the system of care for stroke patients require a ground-upwards, local approach. The accuracy of the triage tools analysed varied, with some lacking specificity and others sensitivity. Triage tools are evolving, and simplistic tools offer comparable accuracy when contrasted with comprehensive alternatives, which require a significantly increased level of assessment skill and time demand. While there is evidence in support of prehospital bypass protocols, this evidence is poorly generalisable owing to a number of variables, with geographical layout being a significant compounding factor.

Stroke is a neurological emergency that results from the disruption of blood supply to part of the brain, either by infarction or haemorrhage. In the UK alone, there are more than 100 000 strokes each year; its mortality is signified by its place as the fourth biggest killer nationally (King's College London, 2018). Despite many advances in management, acute ischaemic stroke remains a leading cause of death and disability in the UK. With the cost to society estimated at £26 billion per year, medical research has focused on improving the initial recognition and treatment of these patients (Patel et al, 2017). In the mid 1990s, the importance of prehospital stroke identification accelerated with the introduction of intravenous tissue-type plasminogen activator (tPA) as a successful management strategy for ischaemic stroke (Cameron et al, 2015). These drugs are effective only if administered rapidly after the onset of stroke symptoms (Cameron et al, 2015).

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Stroke
Prehospital
Thrombectomy
Assessment
Triage
Bypass