Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

Neurological Research and Practice

Christoph Massing¹  Frank Maier¹  Hans-Michael Lamberty²  Volkmar Fischer³  Andreas Binder⁴  Jürgen Guldner⁵  Achim Magull-Seltenreich⁵  Michael Gawlitza⁶  Katrin Donnevert⁶  Johannes Schuler⁷  Robert Liszka⁷  Stefan Jung⁸  Silke Tonner⁹  Matthias Strittmatter⁹  Stefanie Behnke^1,10  Benedikt Trauth^1,10  Martin Lesmeister^1,10  Monika Bachhuber^1,10  Klaus Fassbender^1,10  Fatma Merzou^1,10  Luca Tarantini^1,10  Andreas Ragoschke-Schumm^1,10  Silke Walter^1,10  Wolfgang Reith^1,11  Iris Q. Grunwald^1,12  Elmar Spüntrup^1,13  Stefan Wagenpfeil^1,14  Thomas Bertsch^1,15  Thomas Schlechtriemen^1,16  Lukas Hoor^1,16  Mark Becker^1,16 

[1] Department of Neurology, Caritas-Klinikum Saarbrücken St. Theresia, Saarbrücken, Germany;Department of Neurology, DRK Krankenhaus Saarlouis, Saarlouis, Germany;Department of Neurology, Diakonie Klinikum Neunkirchen, Neunkirchen/Saar, Germany;Department of Neurology, Klinikum Saarbrücken, Saarbrücken, Germany;Department of Neurology, Knappschaftsklinikum Saar, Püttlingen, Germany;Department of Neurology, Knappschaftsklinikum Saar, Sulzbach, Germany;Department of Neurology, Marienhaus Klinik St. Wendel, St. Wendel, Germany;Department of Neurology, Marienhaus Klinikum Saarlouis-Dillingen, Dillingen, Germany;Department of Neurology, SHG Klinikum Merzig, Merzig, Germany;Department of Neurology, Saarland University Medical Center, Kirrberger St. Bldg. 90, 66421, Homburg, Germany;Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany;Department of Neuroscience, Medical School, Anglia Ruskin University, Chelmsford, UK;Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, UK;Department of Radiology, Klinikum Saarbrücken, Saarbrücken, Germany;Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany;Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany;Zweckverband für Rettungsdienst und Feuerwehralarmierung Saar, Bexbach, Germany;

关键词: Prehospital;    Large-vessel occlusion;    Emergency medical services;    Triage;    Preclinical scale;    Thrombectomy;   

DOI  :  10.1186/s42466-021-00128-x

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsProspective 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.ResultsIn 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%).ConclusionsState-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.

【 授权许可】

CC BY