Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Jul;9(7):631-635.
doi: 10.1136/neurintsurg-2016-012476. Epub 2016 Jun 24.

Stroke care: initial data from a county-based bypass protocol for patients with acute stroke

Syed F Zaidi  1 , Julie Shawver  2 , Aixa Espinosa Morales  1 , Hisham Salahuddin  1 , Gretchen Tietjen  1 , David Lindstrom  2 , Brent Parquette  3 , Andrea Adams  4 , Andrea Korsnack  1 , Mouhammad A Jumaa  1
Affiliations
Multicenter Study

Stroke care: initial data from a county-based bypass protocol for patients with acute stroke

Syed F Zaidi et al. J Neurointerv Surg. 2017 Jul.

Abstract

Background: Early identification and transfer of patients with acute stroke to a primary or comprehensive stroke center results in favorable outcomes.

Objective: To describe implementation and results of an emergency medical service (EMS)-driven stroke protocol in Lucas County, Ohio.

Method: All county EMS personnel (N=464) underwent training in the Rapid Arterial oCclusion Evaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke and a RACE score ≥5 were taken to a facility that offered advanced therapy, was implemented in July 2015. During the 6-month study period, 109 RAs were activated. Time efficiencies, diagnostic accuracy, and mechanical thrombectomy (MT) outcomes were compared with standard 'stroke-alert' (N=142) patients from the preceding 6 months.

Results: An increased treatment rate (25.6% vs 12.6%, p<0.05) and improved time efficiency (median door-to-CT 10 vs 28 min, p<0.05; door-to-needle 46 vs 75 min, p<0.05) of IV tissue plasminogen activator within the RA cohort was achieved. The rate of MT (20.1% vs 7.7%, p=0.06) increased and treatment times improved, including median arrival-to-puncture (68 vs 128 min, p=0.04) and arrival-to-recanalization times (101 vs 205 min, p=0.001) in favor of the RA cohort. A non-significant trend towards improved outcome (50% vs 36.4%, p=0.3) in the RA cohort was noted. The RA protocol also showed improved diagnostic specificity for ischemic stroke (52.3% vs 30.1%, p<0.05).

Conclusions: Our results indicate that EMS adaptation of the RA protocol within Lucas County is feasible and effective for early triage and treatment of patients with stroke. Using this protocol, we can significantly improve treatment times for both systemic thrombolysis and MT.

Keywords: Standards; Stroke.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Lucas County stroke centers.
Figure 2
Figure 2
Lucas County Rapid Arterial oCclusion Evaluation (RACE) Alert protocol. CAD, coronary artery disease; CVA, cerebrovascular accident; ED, emergency department.
Figure 3
Figure 3
Emergency room protocol. ED, emergency department; EMS, emergency medical service; NIHSS, National Institutes of Health Stroke Scale; PT/INR, prothrombin time/international normalized ratio; RACE, Rapid Arterial oCclusion Evaluation; RN, registered nurse.
See this image and copyright information in PMC

References

    1. Powers WJ, Derdeyn CP, Biller J, et al. . 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: a Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015;46:3020–35. 10.1161/STR.0000000000000074 - DOI - PubMed
    1. Berkhemer OA, Fransen PS, Beumer D, et al. . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20. 10.1056/NEJMoa1411587 - DOI - PubMed
    1. Khatri P, Yeatts SD, Mazighi M, et al. . Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol 2014;13:567–74. 10.1016/S1474-4422(14)70066-3 - DOI - PMC - PubMed
    1. Smith EE, Schwamm LH. Endovascular clot retrieval therapy: implications for the organization of stroke systems of care in North America. Stroke 2015;46:1462–7. 10.1161/STROKEAHA.115.008385 - DOI - PubMed
    1. Jayaraman MV, Iqbal A, Silver B, et al. . Developing a statewide protocol to ensure patients with suspected emergent large vessel occlusion are directly triaged in the field to a comprehensive stroke center: how we did it. J Neurointerv Surg Published Online First: 3 Mar 2016. doi:10.1136/neurintsurg-2016-012275 10.1136/neurintsurg-2016-012275 - DOI - PubMed

Publication types

MeSH terms