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Article ; Online: Medical attention seeking by suspected stroke patients: Emergency medical services or general practitioner?

Duvekot, Martijne H C / Kerkhoff, Henk / Venema, Esmee / Bos, Hans W D J C / Smeekes, David / Buijck, Bianca Ivonne / Rozeman, Anouk D / Moudrous, Walid / Vermeij, Frédérique H / Lycklama À Nijeholt, Geert J / Jan van Doormaal, Pieter / van Es, Adriaan C G M / van der Lugt, Aad / Dippel, Diederik / Roozenbeek, Bob

Clinical neurology and neurosurgery

2022 Volume 218, Page(s) 107297

Abstract: Objective: Awareness campaigns advise the public to call emergency medical services (EMS) directly in case of suspected stroke. We aimed to explore patient and notification characteristics that influence direct EMS notification, the time to alert, and ... ...

Abstract	Objective: Awareness campaigns advise the public to call emergency medical services (EMS) directly in case of suspected stroke. We aimed to explore patient and notification characteristics that influence direct EMS notification, the time to alert, and the time to treatment. Methods: We performed a secondary analysis with data from the PRESTO study, a multi-center prospective observational cohort study that included patients with suspected stroke. We used multivariable binary logistic regression analyses to assess the association with direct EMS notification and multivariable linear regression analyses to assess the association with the onset-to-alert time, onset-to-needle time and onset-to-groin time. Results: Of 436 included patients, 208 patients (48%) contacted EMS directly. FAST scores (aOR 1.45 for every point increase, 95%CI: 1.14-1.86), alert outside office hours (aOR 1.64 [1.05-2.55]), and onset-to-alert time (aOR for every minute less [≤55 min]: 0.96 [0.95-0.97]) were independently associated with direct EMS notification. Direct EMS call was independently associated with shorter onset-to-alert times (27 min [54-0.84]) and with shorter onset-to-needle times (-30 min [-51 to -10]). The association between direct EMS call and the onset-to-groin time was almost similar to the association with onset-to-needle time, though not statistically significant (univariable analysis: 23.7 min decrease [-103.7 to 56.2]). Conclusion: More than half of all patients with suspected stroke do not call EMS directly but call their GP instead. Patients with higher FAST scores, alert outside office hours, and a rapid alert, more often call EMS directly. Patients who call EMS directly are treated with IVT 30 min faster than patients who call the GP first. Trial registration number: Netherlands Trial Register: NL7387, (www.trialregister.nl).
MeSH term(s)	Emergency Medical Services ; General Practitioners ; Humans ; Prospective Studies ; Stroke/diagnosis ; Stroke/therapy ; Time Factors ; Time-to-Treatment
Language	English
Publishing date	2022-05-21
Publishing country	Netherlands
Document type	Journal Article ; Observational Study
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2022.107297
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Article ; Online: Evaluating the Diagnostic Performance of Prehospital Stroke Scales Across the Range of Deficit Severity: Analysis of the Prehospital Triage of Patients With Suspected Stroke Study.

Ganesh, Aravind / van de Wijdeven, Ruben M / Ospel, Johanna M / Duvekot, Martijne H C / Venema, Esmee / Rozeman, Anouk D / Moudrous, Walid / Dorresteijn, Kirsten R I S / Hensen, Jan-Hein / van Es, Adriaan C G M / van der Lugt, Aad / Kerkhoff, Henk / Dippel, Diederik W J / Goyal, Mayank / Roozenbeek, Bob

Stroke

2022 Volume 53, Issue 12, Page(s) 3605–3615

Abstract: Background: The usefulness of prehospital scales for identifying anterior circulation large vessel occlusion (aLVO) in patients with suspected stroke may vary depending on the severity of their presentation. The performance of these scales across the ... ...

Abstract	Background: The usefulness of prehospital scales for identifying anterior circulation large vessel occlusion (aLVO) in patients with suspected stroke may vary depending on the severity of their presentation. The performance of these scales across the spectrum of deficit severity is unclear. The aim of this study was to evaluate the diagnostic performance of 8 prehospital scales for identifying aLVO across the spectrum of deficit severity. Methods: We used data from the PRESTO study (Prehospital Triage of Patients With Suspected Stroke Symptoms), a prospective observational study comparing prehospital stroke scales in detecting aLVO in suspected stroke patients. We used the National Institutes of Health Stroke Scale (NIHSS) score, assessed in-hospital, as a proxy for the Clinical Global Impression of stroke severity during prehospital assessment by paramedics. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, and the difference in aLVO probabilities with a positive or negative prehospital scale test (ΔP Results: Among 1033 patients with suspected stroke, 119 (11.5%) had an aLVO, of whom 19 (16.0%) had mild, 25 (21.0%) had intermediate, 30 (25.2%) had moderate, and 45 (37.8%) had severe deficits. The scales had low sensitivity and positive predictive value in patients with mild-intermediate deficits, and poor specificity, negative predictive value, and accuracy with moderate-severe deficits. Positive results achieved the highest ΔP Conclusions: Commonly-used prehospital stroke scales show variable performance across the range of deficit severity. Probability of aLVO remains high with a negative test in severely affected patients. Studies reporting prehospital stroke scale performance should be appraised in the context of the NIHSS distribution of their samples.
MeSH term(s)	Humans ; Triage/methods ; Sensitivity and Specificity ; Stroke/diagnosis ; Predictive Value of Tests ; Prospective Studies ; Emergency Medical Services/methods ; Severity of Illness Index ; Brain Ischemia/diagnosis
Language	English
Publishing date	2022-10-21
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.122.039825
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Article ; Online: Prehospital Stroke Triage: A Modeling Study on the Impact of Triage Tools in Different Regions.

Duvekot, Martijne H C / Garcia, Bjarty L / Dekker, Luuk / Nguyen, Truc My / van den Wijngaard, Ido R / de Laat, Karlijn F / de Schryver, Els L L M / Kloos, Loet M H / Aerden, Leo A M / Zylicz, Stas A / Bosch, Jan / van Belle, Eduard / van Zwet, Erik W / Rozeman, Anouk D / Moudrous, Walid / Vermeij, Frédérique H / Lingsma, Hester F / Bakker, Jeannette / van Doormaal, Pieter Jan /

van Es, Adriaan C G M / van der Lugt, Aad / Wermer, Marieke J H / Dippel, Diederik W J / Kerkhoff, Henk / Roozenbeek, Bob / Kruyt, Nyika D / Venema, Esmee

Prehospital emergency care

2023 Volume 27, Issue 5, Page(s) 630–638

Abstract: Background and purpose: Direct transportation to a thrombectomy-capable intervention center is beneficial for patients with ischemic stroke due to large vessel occlusion (LVO), but can delay intravenous thrombolytics (IVT). The aim of this modeling ... ...

Abstract	Background and purpose: Direct transportation to a thrombectomy-capable intervention center is beneficial for patients with ischemic stroke due to large vessel occlusion (LVO), but can delay intravenous thrombolytics (IVT). The aim of this modeling study was to estimate the effect of prehospital triage strategies on treatment delays and overtriage in different regions. Methods: We used data from two prospective cohort studies in the Netherlands: the Leiden Prehospital Stroke Study and the PRESTO study. We included stroke code patients within 6 h from symptom onset. We modeled outcomes of Rapid Arterial oCclusion Evaluation (RACE) scale triage and triage with a personalized decision tool, using drip-and-ship as reference. Main outcomes were overtriage (stroke code patients incorrectly triaged to an intervention center), reduced delay to endovascular thrombectomy (EVT), and delay to IVT. Results: We included 1798 stroke code patients from four ambulance regions. Per region, overtriage ranged from 1-13% (RACE triage) and 3-15% (personalized tool). Reduction of delay to EVT varied by region between 24 ± 5 min ( Conclusions: In this modeling study, we showed that prehospital triage reduced time to EVT without disproportionate IVT delay, compared to a drip-and-ship strategy. The effect of triage strategies and the associated overtriage varied between regions. Implementation of prehospital triage should therefore be considered on a regional level.
MeSH term(s)	Humans ; Triage ; Brain Ischemia/diagnosis ; Emergency Medical Services ; Prospective Studies ; Stroke/therapy ; Stroke/drug therapy ; Fibrinolytic Agents/therapeutic use ; Thrombolytic Therapy ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2023-06-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2023.2215859
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Article ; Online: Comparison of Prehospital Assessment by Paramedics and In-Hospital Assessment by Physicians in Suspected Stroke Patients: Results From 2 Prospective Cohort Studies.

Stroke

2023 Volume 54, Issue 9, Page(s) 2279–2285

Abstract: Background: It is unknown if ambulance paramedics adequately assess neurological deficits used for prehospital stroke scales to detect anterior large-vessel occlusions. We aimed to compare prehospital assessment of these stroke-related deficits by ... ...

Abstract	Background: It is unknown if ambulance paramedics adequately assess neurological deficits used for prehospital stroke scales to detect anterior large-vessel occlusions. We aimed to compare prehospital assessment of these stroke-related deficits by paramedics with in-hospital assessment by physicians. Methods: We used data from 2 prospective cohort studies: the LPSS (Leiden Prehospital Stroke Study) and PRESTO study (Prehospital Triage of Patients With Suspected Stroke). In both studies, paramedics scored 9 neurological deficits in stroke code patients in the field. Trained physicians scored the National Institutes of Health Stroke Scale (NIHSS) at hospital presentation. Patients with transient ischemic attack were excluded because of the transient nature of symptoms. Spearman rank correlation coefficient (r Results: We included 2850 stroke code patients. Of these, 1528 had ischemic stroke, 243 intracranial hemorrhage, and 1079 stroke mimics. Correlation between the total prehospital assessment score and NIHSS score was strong (r Conclusions: The overall prehospital assessment of stroke code patients correlates strongly with in-hospital assessment. Prehospital assessment of neglect, abnormal speech, and gaze deviation differed most from in-hospital assessment. Focused training on these deficits may improve prehospital triage.
MeSH term(s)	Humans ; Emergency Medical Services/methods ; Paramedics ; Prospective Studies ; Stroke ; Triage/methods ; Hospitals ; Physicians
Language	English
Publishing date	2023-07-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.123.042644
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Article ; Online: Prehospital triage of patients with suspected stroke symptoms (PRESTO): protocol of a prospective observational study.

Venema, Esmee / Duvekot, Martijne H C / Lingsma, Hester F / Rozeman, Anouk D / Moudrous, Walid / Vermeij, Frederique H / Biekart, Marileen / van der Lugt, Aad / Kerkhoff, Henk / Dippel, Diederik W J / Roozenbeek, Bob

BMJ open

2019 Volume 9, Issue 7, Page(s) e028810

Abstract: Introduction: The efficacy of both intravenous treatment (IVT) and endovascular treatment (EVT) for patients with acute ischaemic stroke strongly declines over time. Only a subset of patients with ischaemic stroke caused by an intracranial large vessel ... ...

Abstract	Introduction: The efficacy of both intravenous treatment (IVT) and endovascular treatment (EVT) for patients with acute ischaemic stroke strongly declines over time. Only a subset of patients with ischaemic stroke caused by an intracranial large vessel occlusion (LVO) in the anterior circulation can benefit from EVT. Several prehospital stroke scales were developed to identify patients that are likely to have an LVO, which could allow for direct transportation of EVT eligible patients to an endovascular-capable centre without delaying IVT for the other patients. We aim to prospectively validate these prehospital stroke scales simultaneously to assess their accuracy in predicting LVO in the prehospital setting. Methods and analysis: Prehospital triage of patients with suspected stroke symptoms (PRESTO) is a prospective multicentre observational cohort study in the southwest of the Netherlands including adult patients with suspected stroke in the ambulance. The paramedic will assess a combination of items from five prehospital stroke scales, without changing the normal workflow. Primary outcome is the clinical diagnosis of an acute ischaemic stroke with an intracranial LVO in the anterior circulation. Additional hospital data concerning the diagnosis and provided treatment will be collected by chart review. Logistic regression analysis will be performed, and performance of the prehospital stroke scales will be expressed as sensitivity, specificity and area under the receiver operator curve. Ethics and dissemination: The Institutional Review Board of the Erasmus MC University Medical Centre has reviewed the study protocol and confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) is not applicable. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations. The best performing scale, or the simplest scale in case of clinical equipoise, will be integrated in a decision model with other clinical characteristics and real-life driving times to improve prehospital triage of suspected stroke patients. Trial registration number: NTR7595.
MeSH term(s)	Carotid Artery Thrombosis/diagnosis ; Carotid Artery Thrombosis/therapy ; Carotid Artery, Internal ; Emergency Medical Services/methods ; Endovascular Procedures ; Humans ; Infarction, Anterior Cerebral Artery/diagnosis ; Infarction, Anterior Cerebral Artery/therapy ; Infarction, Middle Cerebral Artery/diagnosis ; Infarction, Middle Cerebral Artery/therapy ; Logistic Models ; Netherlands ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Stroke/diagnosis ; Thrombectomy ; Thrombolytic Therapy ; Triage/methods
Language	English
Publishing date	2019-07-09
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2018-028810
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Article ; Online: Effect of sensory stimuli on restless legs syndrome: a randomized crossover study.

Rozeman, Anouk D / Ottolini, Truus / Grootendorst, Diana C / Vogels, Oscar J M / Rijsman, Roselyne M

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

2014 Volume 10, Issue 8, Page(s) 893–896

Abstract: Study objective: A variety of sensory stimuli relieve restless legs syndrome symptoms. Because systematic evaluations of sensory stimulation in restless legs syndrome are largely lacking, we performed a randomized crossover study to evaluate the effect ... ...

Abstract	Study objective: A variety of sensory stimuli relieve restless legs syndrome symptoms. Because systematic evaluations of sensory stimulation in restless legs syndrome are largely lacking, we performed a randomized crossover study to evaluate the effect of external sensory stimulation on restless legs syndrome symptoms. Methods: Eighteen patients underwent 3 consecutive suggestive immobilization tests with the order of the following 3 conditions randomly assigned: no electrical stimulation (condition 1), tactile and proprioceptive sensory stimulation (condition 2), and tactile sensory stimulation only (condition 3). Restless legs syndrome symptoms were quantified by visual analog scales, and periodic leg movements during wake were measured. Results: Baseline visual analogue scale score was 4.5 (range 0-60) in condition 1, 10.5 (range 0-96) in condition 2, and 8.5 in condition 3 (p = 0.21). There was a tendency towards a higher maximum visual analogue scale score and visual analogue scale score at the end of the suggested immobilization test in the conditions with tactile sensory stimulation, though not significant (p = 0.74 and p = 0.29, respectively). Fifteen patients suffered from periodic leg movements during wake. Median indices were 18 (range 0-145) in condition 1, 26 (range 0-190) in condition 2, and 49 (range 0-228) in condition 3 (p = 0.76). Conclusions: We found a tendency towards less leg discomfort in the conditions in which an external sensory input was applied. This potential benefit of sensory stimuli on restless legs syndrome severity merits further investigation as this could open new ways towards a better pathophysiological understanding and non-pharmacological treatments.
MeSH term(s)	Adult ; Aged ; Cross-Over Studies ; Electric Stimulation/methods ; Female ; Humans ; Male ; Middle Aged ; Physical Stimulation/methods ; Proprioception ; Restless Legs Syndrome/therapy ; Touch ; Treatment Outcome ; Visual Analog Scale
Language	English
Publishing date	2014-08-15
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2397213-0
ISSN	1550-9397 ; 1550-9389
ISSN (online)	1550-9397
ISSN	1550-9389
DOI	10.5664/jcsm.3964
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Article ; Online: Accuracy of CTA evaluations in daily clinical practice for large and medium vessel occlusion detection in suspected stroke patients.

Duvekot, Martijne H C / van Es, Adriaan C G M / Venema, Esmee / Wolff, Lennard / Rozeman, Anouk D / Moudrous, Walid / Vermeij, Frédérique H / Lingsma, Hester F / Bakker, Jeannette / Plaisier, Aarnout S / Hensen, Jan-Hein J / Lycklama À Nijeholt, Geert J / Jan van Doormaal, Pieter / Dippel, Diederik W J / Kerkhoff, Henk / Roozenbeek, Bob / van der Lugt, Aad

European stroke journal

2021 Volume 6, Issue 4, Page(s) 357–366

Abstract: Introduction: Early detection of large vessel occlusion (LVO) is essential to facilitate fast endovascular treatment. CT angiography (CTA) is used to detect LVO in suspected stroke patients. We aimed to assess the accuracy of CTA evaluations in daily ... ...

Abstract	Introduction: Early detection of large vessel occlusion (LVO) is essential to facilitate fast endovascular treatment. CT angiography (CTA) is used to detect LVO in suspected stroke patients. We aimed to assess the accuracy of CTA evaluations in daily clinical practice in a large cohort of suspected stroke patients. Patients and methods: We used data from the PRESTO study, a multicenter prospective observational cohort study that included suspected stroke patients between August 2018 and September 2019. Baseline CTAs were re-evaluated by an imaging core laboratory and compared to the local assessment. LVO was defined as an occlusion of the intracranial internal carotid artery, M1 segment, or basilar artery. Medium vessel occlusion (MeVO) was defined as an A1, A2, or M2 occlusion. We calculated the accuracy, sensitivity, and specificity to detect LVO and LVO+MeVO, using the core laboratory evaluation as reference standard. Results: We included 656 patients. The core laboratory detected 89 LVOs and 74 MeVOs in 155 patients. Local observers missed 6 LVOs (7%) and 28 MeVOs (38%), of which 23 M2 occlusions. Accuracy of LVO detection was 99% (95% CI: 98-100%), sensitivity 93% (95% CI: 86-97%), and specificity 100% (95% CI: 99-100%). Accuracy of LVO+MeVO detection was 95% (95% CI: 93-96%), sensitivity 79% (95% CI: 72-85%), and specificity 99% (95% CI: 98-100%). Discussion and conclusion: CTA evaluations in daily clinical practice are highly accurate and LVOs are adequately recognized. The detection of MeVOs seems more challenging. The evolving EVT possibilities emphasize the need to improve CTA evaluations in the acute setting.
Language	English
Publishing date	2021-11-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2851287-X
ISSN	2396-9881 ; 2396-9873
ISSN (online)	2396-9881
ISSN	2396-9873
DOI	10.1177/23969873211058576
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Article ; Online: Duplex ultrasonography for the detection of vertebral artery stenosis: A comparison with CT angiography.

Rozeman, Anouk D / Hund, Hajo / Westein, Michel / Wermer, Marieke J H / Lycklama À Nijeholt, Geert J / Boiten, Jelis / Schimsheimer, Robert-Jan / Algra, Ale

Brain and behavior

2017 Volume 7, Issue 8, Page(s) e00750

Abstract: Objectives: Vertebrobasilar stenosis is frequent in patients with posterior circulation stroke and it increases risk of recurrence. We investigated feasibility of duplex ultrasonography (DUS) for screening for extracranial vertebral artery stenosis and ... ...

Abstract	Objectives: Vertebrobasilar stenosis is frequent in patients with posterior circulation stroke and it increases risk of recurrence. We investigated feasibility of duplex ultrasonography (DUS) for screening for extracranial vertebral artery stenosis and compared it with CT angiography (CTA). Materials and methods: We gathered data on 337 consecutive patients who had DUS because of posterior circulation stroke or TIA. Matching CTA studies were retrieved and used as reference. Stenosis on CTA was considered "significant" if >50%, at DUS if Peak Systolic Velocity (PSV) > 140 cm/s for the V1 segment and PSV > 125 cm/s for the V2 segment. We determined the area under the ROC curve (AUROC). In addition, we calculated which PSV cut-off value resulted in highest sensitivity with acceptable specificity. Results: DUS was able to make an adequate measurement in 378 of 674 V1 segments and 673 of 674 V2 segments. DUS detected a significant stenosis in 52 of 378 V1 segments; 12 were confirmed by CTA (AUROC 0.73, 95% Confidence Interval 0.63-0.83). The optimal DUS PSV cut-off value for this segment was 90 cm/s. For the V2 segment there were too few stenoses to allow reliable assessment of diagnostic characteristics of DUS. Conclusions: Although DUS has a fair AUROC for detecting significant stenosis, adequate assessment of the V1 segment is often not possible due to anatomic difficulties. Assessment of the V2 segment is feasible but yielded few stenoses. Hence, we consider usefulness of DUS for screening of extracranial vertebral artery stenosis limited.
MeSH term(s)	Aged ; Area Under Curve ; Carotid Stenosis ; Computed Tomography Angiography/methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Stroke/etiology ; Ultrasonography, Doppler, Duplex/methods ; Vertebral Artery/diagnostic imaging ; Vertebrobasilar Insufficiency/complications ; Vertebrobasilar Insufficiency/diagnosis ; Vertebrobasilar Insufficiency/physiopathology
Language	English
Publishing date	2017-06-29
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2623587-0
ISSN	2162-3279 ; 2162-3279
ISSN (online)	2162-3279
ISSN	2162-3279
DOI	10.1002/brb3.750
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Article ; Online: Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study.

Duvekot, Martijne H C / Venema, Esmee / Rozeman, Anouk D / Moudrous, Walid / Vermeij, Frédérique H / Biekart, Marileen / Lingsma, Hester F / Maasland, Lisette / Wijnhoud, Annemarie D / Mulder, Laus J M M / Alblas, Kees C L / van Eijkelenburg, Roeland P J / Buijck, Bianca I / Bakker, Jeannette / Plaisier, Aarnout S / Hensen, Jan-Hein / Lycklama À Nijeholt, Geert J / van Doormaal, Pieter Jan / van Es, Adriaan C G M /

van der Lugt, Aad / Kerkhoff, Henk / Dippel, Diederik W J / Roozenbeek, Bob

The Lancet. Neurology

2021 Volume 20, Issue 3, Page(s) 213–221

Abstract: Background: Due to the time-sensitive effect of endovascular treatment, rapid prehospital identification of large-vessel occlusion in individuals with suspected stroke is essential to optimise outcome. Interhospital transfers are an important cause of ... ...

Abstract	Background: Due to the time-sensitive effect of endovascular treatment, rapid prehospital identification of large-vessel occlusion in individuals with suspected stroke is essential to optimise outcome. Interhospital transfers are an important cause of delay of endovascular treatment. Prehospital stroke scales have been proposed to select patients with large-vessel occlusion for direct transport to an endovascular-capable intervention centre. We aimed to prospectively validate eight prehospital stroke scales in the field. Methods: We did a multicentre, prospective, observational cohort study of adults with suspected stroke (aged ≥18 years) who were transported by ambulance to one of eight hospitals in southwest Netherlands. Suspected stroke was defined by a positive Face-Arm-Speech-Time (FAST) test. We included individuals with blood glucose of at least 2·5 mmol/L. People who presented more than 6 h after symptom onset were excluded from the analysis. After structured training, paramedics used a mobile app to assess items from eight prehospital stroke scales: Rapid Arterial oCclusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), Cincinnati Stroke Triage Assessment Tool (C-STAT), Gaze-Face-Arm-Speech-Time (G-FAST), Prehospital Acute Stroke Severity (PASS), Cincinnati Prehospital Stroke Scale (CPSS), Conveniently-Grasped Field Assessment Stroke Triage (CG-FAST), and the FAST-PLUS (Face-Arm-Speech-Time plus severe arm or leg motor deficit) test. The primary outcome was the clinical diagnosis of ischaemic stroke with a proximal intracranial large-vessel occlusion in the anterior circulation (aLVO) on CT angiography. Baseline neuroimaging was centrally assessed by neuroradiologists to validate the true occlusion status. Prehospital stroke scale performance was expressed as the area under the receiver operating characteristic curve (AUC) and was compared with National Institutes of Health Stroke Scale (NIHSS) scores assessed by clinicians at the emergency department. This study was registered at the Netherlands Trial Register, NL7387. Findings: Between Aug 13, 2018, and Sept 2, 2019, 1039 people (median age 72 years [IQR 61-81]) with suspected stroke were identified by paramedics, of whom 120 (12%) were diagnosed with aLVO. Of all prehospital stroke scales, the AUC for RACE was highest (0·83, 95% CI 0·79-0·86), followed by the AUC for G-FAST (0·80, 0·76-0·84), CG-FAST (0·80, 0·76-0·84), LAMS (0·79, 0·75-0·83), CPSS (0·79, 0·75-0·83), PASS (0·76, 0·72-0·80), C-STAT (0·75, 0·71-0·80), and FAST-PLUS (0·72, 0·67-0·76). The NIHSS as assessed by a clinician in the emergency department did somewhat better than the prehospital stroke scales with an AUC of 0·86 (95% CI 0·83-0·89). Interpretation: Prehospital stroke scales detect aLVO with acceptable-to-good accuracy. RACE, G-FAST, and CG-FAST are the best performing prehospital stroke scales out of the eight scales tested and approach the performance of the clinician-assessed NIHSS. Further studies are needed to investigate whether use of these scales in regional transportation strategies can optimise outcomes of patients with ischaemic stroke. Funding: BeterKeten Collaboration and Theia Foundation (Zilveren Kruis).
MeSH term(s)	Aged ; Aged, 80 and over ; Arterial Occlusive Diseases/cerebrospinal fluid ; Arterial Occlusive Diseases/complications ; Arterial Occlusive Diseases/diagnosis ; Cohort Studies ; Computed Tomography Angiography ; Emergency Medical Services/statistics & numerical data ; Female ; Humans ; Ischemic Stroke/cerebrospinal fluid ; Ischemic Stroke/diagnosis ; Ischemic Stroke/etiology ; Male ; Middle Aged ; Netherlands ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Treatment Outcome
Language	English
Publishing date	2021-01-07
Publishing country	England
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2081241-3
ISSN	1474-4465 ; 1474-4422
ISSN (online)	1474-4465
ISSN	1474-4422
DOI	10.1016/S1474-4422(20)30439-7
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Article ; Online: Evolution of Intra-arterial Therapy for Acute Ischemic Stroke in The Netherlands: MR CLEAN Pretrial Experience.

Rozeman, Anouk D / Wermer, Marieke J H / Vos, Jan Albert / Lycklama à Nijeholt, Geert J / Beumer, Debbie / Berkhemer, Olvert A / Dippel, Diederik W J / Algra, Ale / Boiten, Jelis / Schonewille, Wouter J

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2016 Volume 25, Issue 1, Page(s) 115–121

Abstract: Introduction: The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) trial showed efficacy of intra-arterial (IA) treatment in acute ischemic stroke (AIS). We studied the evolution of ... ...

Abstract	Introduction: The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) trial showed efficacy of intra-arterial (IA) treatment in acute ischemic stroke (AIS). We studied the evolution of IA treatment for AIS and its effects on clinical outcome and recanalization in The Netherlands in the pre-MR CLEAN era. Methods: Data on 517 patients with AIS treated with IA therapy were collected retrospectively from all intervention centers in The Netherlands from 2002 to the start of participation in the MR CLEAN trial. Clinical outcome was measured by means of the modified Rankin Scale score and recanalization with the Thrombolysis in Cerebral Infarction Scale. Results: IA therapy was first used in patients with basilar artery occlusion. Over the years, there was a gradual increase in the number of anterior circulation strokes treated. There was a shift in applied therapies from primary IA therapy to combined intravenous and IA therapy and from IA thrombolysis to mechanical thrombectomy. Time from symptom onset to treatment decreased. Recanalization rates gradually increased. At the same time, there was a trend toward more favorable outcomes after 3 months and fewer deceased patients both at discharge and after 3 months. However, none of these changes reached statistical significance. Conclusion: The treatment approach used in the MR CLEAN trial was the result of an evolution of practise in the preceding years, with gradual improvement in technical and clinical outcomes.
MeSH term(s)	Acute Disease ; Aged ; Brain Ischemia/drug therapy ; Brain Ischemia/epidemiology ; Brain Ischemia/surgery ; Cerebral Hemorrhage/chemically induced ; Combined Modality Therapy ; Databases, Factual ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Fibrinolytic Agents/therapeutic use ; Humans ; Infusions, Intra-Arterial/adverse effects ; Infusions, Intravenous ; Male ; Middle Aged ; Netherlands/epidemiology ; Retrospective Studies ; Severity of Illness Index ; Thrombectomy/adverse effects ; Thrombectomy/instrumentation ; Thrombectomy/trends ; Thrombectomy/utilization ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/trends ; Thrombolytic Therapy/utilization ; Tissue Plasminogen Activator/administration & dosage ; Tissue Plasminogen Activator/adverse effects ; Tissue Plasminogen Activator/therapeutic use ; Treatment Outcome ; Vasospasm, Intracranial/etiology
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2015.09.002
Database	MEDical Literature Analysis and Retrieval System OnLINE

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