TRIAGE IN THE EMERGENCY DEPARTMENT (The Australasian Triage Scale)
Optimizing pre-hospital triage and transfer pathways for ... pre... · Optimizing pre-hospital...
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1 Stroke Unit. Neurology Dpt. Hospital Universitari Vall d’Hebron. Barcelona. Optimizing pre-hospital triage and transfer pathways for LVO stroke - lessons from RACECAT Marc Ribo Stroke Option A Option B Uchino K, for the CLOTBUST Collaborators ISC 2003 11% 0.22 0.07-0.76 29% 0.71 0.41-1.2 44 % 2.12 1.21-3.71 Prob. OR 95% IC n=250 TIBI 1 TIBI 5 + 1 hour iv-tPA
Transcript of Optimizing pre-hospital triage and transfer pathways for ... pre... · Optimizing pre-hospital...
1Stroke Unit. Neurology Dpt.Hospital Universitari Vall d’Hebron. Barcelona.
Optimizing pre-hospital triage and transfer pathways for LVO stroke - lessons from RACECAT
Marc Ribo
Stroke
Option A
Option B
Uchino K, for the CLOTBUST Collaborators ISC 2003
11% 0.22 0.07-0.76
29% 0.71 0.41-1.2
44 % 2.12 1.21-3.71
Prob. OR 95% ICn=250
TIBI 1 TIBI 5
+ 1 houriv-tPA
Stroke Unit
Stroke Unit
Comprehensive Stroke Centers
Primary Stroke Centers
100 Pre-Hospital Acute Stroke Codes
Mimic
Ischemic LVO-
Ischemic LVO+
ICH
100 Pre-Hospital Acute Stroke Codes
Comprehensive StrokeCenter
PrimaryStroke Center
Expert StrokeNeurologist
Geo- location
Remote assessment
Stroke Mimic
Ischemic LVO-
Ischemic LVO+
ICH
Mimic
Ischemic LVO-
Ischemic LVO+
ICH
100 Pre-Hospital Acute Stroke Codes
Perfect Screen
16 minutesreduction
Probability of Large Vessel Occlusion
TRIAGE
Mimic
Ischemic LVO-
Ischemic LVO+
ICH
100 Pre-Hospital Acute Stroke Codes
Perfect Screen
60%Ischemic tPA+
LVO+LVO-ICHMimic
35%Ischemic
LVO+iv-tPA EVT
iv-tPA
EVT
Option A
Shortcut
Case 1
iv-tPA EVT
iv-tPA
EVT
Option A
Shortcut
Recanalization
Case 2
iv-tPA EVT
iv-tPA
EVT
Option A
Shortcut
No LVO
Case 3
iv-tPA
EVT
DIDO
60
EVT
OOODIDODIDODIDODIDO
606060
Stroke Unit
Stroke UnitThe Catalan Stroke Registry
Stroke Codes
Ischemic
Iv-tPA
EVT
Primary EVT
Iv-tPA + EVT
Only iv-tPA
Stroke code AlertsInitial Transfer
Town of initial alert
11.000
PSC
CSC
No stroke ready
Secondary transfers for EVT11.000TransfersTransfers
Transfer TimeEVT / No EVT
ASPECTS at PSCNIHSS at PSC
ASPECTS at CSCNIHSS at ISC
LVO */-
ASPE
CTS
at P
SC
NIHS
S at
PSC
ASPECTS at CSC after transfer
0-5 6-10
Clinical and Neuroimaging Criteria to Improve Transfers to Comprehensive Stroke Centers
for Endovascular Treatment evaluation Rubiera M.ISC 2019, Hawaii
2016
2017
2018
# EVT / #STROKE CODE ACTIVATED(per regions)
Geographical spread of EVT
Increase in absolute number of SC
Increase in absolute number of EVT
Uneaven activation of stroke codes
1
2
Stroke Code activation by EMS1: too rare2: too selective
Barcelona
iv-tPA treatmentsAccording to onset location
EVTAccording to onset location
Town of initial alert
In specific áreas: Better Access to iv-tPA than to EVT
Iv-tPA
EVT
Stroke
Option A
Option B
Stroke
Option A Vs Option B ?
ENDPOINTS:
Option A Vs Option B ?
A B
CVs
CCSECONDARY ENDPOINTS:
Safety / efficacy: according to distance, time from onset
Safety /efficacy in ischemic / hemorrhagic strokes
% patients receiving iv-TPA /EVT
Interim analysis
Interim analysis
Interim analysis
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Expected
Found
RACE SCALE SCORES DISTRIBUTION AT INCLUSION
RACE 5 RACE 6 RACE 7 RACE 8 RACE 9
Median NIHSS at firsthospital:
17 (12-21)
Administrative and Safety Analysis 700*
43
45.4
21
18.5 4.7
28
24
8
7.4
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Expected
Found
Diagnostic at Hospital Arrival
LVO No LVO LVO ? ICH Mimic
43 21Expected
Expected EVT%: Group A: 12%Group B: 35%
Expected EVT%: Group A: 12%Group B: 35%
average 23.5%
Administrative and Safety Analysis n=700*
29.63% of all patients
Found43.2% of all ischemicEVT
