TY - JOUR
T1 - Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice
AU - Behnke, Stefanie
AU - Schlechtriemen, Thomas
AU - Binder, Andreas
AU - Bachhuber, Monika
AU - Becker, Mark
AU - Trauth, Benedikt
AU - Lesmeister, Martin
AU - Spüntrup, Elmar
AU - Walter, Silke
AU - Hoor, Lukas
AU - Ragoschke-Schumm, Andreas
AU - Merzou, Fatma
AU - Tarantini, Luca
AU - Bertsch, Thomas
AU - Guldner, Jürgen
AU - Magull-Seltenreich, Achim
AU - Maier, Frank
AU - Massing, Christoph
AU - Fischer, Volkmar
AU - Gawlitza, Michael
AU - Donnevert, Katrin
AU - Lamberty, Hans-Michael
AU - Jung, Stefan
AU - Strittmatter, Matthias
AU - Tonner, Silke
AU - Schuler, Johannes
AU - Liszka, Robert
AU - Wagenpfeil, Stefan
AU - Grunwald, Iris Q.
AU - Reith, Wolfgang
AU - Fassbender, Klaus
N1 - This work was funded by the Ministry of Health Care and Social Affairs of the Saarland, Germany
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics.Results: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%).Conclusions: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.
AB - Background: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy.Methods: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics.Results: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%).Conclusions: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.
KW - Prehospital
KW - Large-vessel occlusion
KW - Emergency medical services
KW - Triage
KW - Preclinical scale
KW - Thrombectomy
U2 - 10.1186/s42466-021-00128-x
DO - 10.1186/s42466-021-00128-x
M3 - Article
C2 - 34059132
SN - 2524-3489
VL - 3
JO - Neurological research and practice
JF - Neurological research and practice
IS - 1
M1 - 31
ER -