TY - JOUR
T1 - Prehospital Stroke Triage
T2 - A Modeling Study on the Impact of Triage Tools in Different Regions
AU - Duvekot, Martijne H.C.
AU - Garcia, Bjarty L.
AU - on behalf of the Leiden Prehospital Stroke Study and PRESTO Investigators
AU - Dekker, Luuk
AU - Nguyen, Truc My
AU - van den Wijngaard, Ido R.
AU - de Laat, Karlijn F.
AU - de Schryver, Els L.L.M.
AU - Kloos, Loet M.H.
AU - Aerden, Leo A.M.
AU - Zylicz, Stas A.
AU - Bosch, Jan
AU - van Belle, Eduard
AU - van Zwet, Erik W.
AU - Rozeman, Anouk D.
AU - Moudrous, Walid
AU - Vermeij, Frédérique H.
AU - Lingsma, Hester F.
AU - Bakker, Jeannette
AU - van Doormaal, Pieter Jan
AU - van Es, Adriaan C.G.M.
AU - van der Lugt, Aad
AU - Wermer, Marieke J.H.
AU - Dippel, Diederik W.J.
AU - Kerkhoff, Henk
AU - Roozenbeek, Bob
AU - Kruyt, Nyika D.
AU - Venema, Esmee
N1 - Funding: The LPSS was funded by the Dutch Brain Foundation, the DutchHealth Care Insurers Innovation Foundation, and Health Holland. ThePRESTO study was funded by the BeterKeten collaboration and TheiaFoundation (Zilveren Kruis)
Publisher Copyright:
© 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2023/8
Y1 - 2023/8
N2 - 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 (n = 6) to 78 ± 3 (n = 2), while IVT delay increased with 5 (n = 5) to 15 min (n = 21) for non-LVO patients. The personalized tool reduced delay to EVT for more patients (25 ± 4 min [n = 8] to 49 ± 13 [n = 5]), while delaying IVT with 3-14 min (8-24 patients). In region C, most EVT patients were treated faster (reduction of delay to EVT 31 ± 6 min (n = 35), with RACE triage and the personalized tool. 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.
AB - 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 (n = 6) to 78 ± 3 (n = 2), while IVT delay increased with 5 (n = 5) to 15 min (n = 21) for non-LVO patients. The personalized tool reduced delay to EVT for more patients (25 ± 4 min [n = 8] to 49 ± 13 [n = 5]), while delaying IVT with 3-14 min (8-24 patients). In region C, most EVT patients were treated faster (reduction of delay to EVT 31 ± 6 min (n = 35), with RACE triage and the personalized tool. 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.
UR - http://www.scopus.com/inward/record.url?scp=85163148748&partnerID=8YFLogxK
U2 - 10.1080/10903127.2023.2215859
DO - 10.1080/10903127.2023.2215859
M3 - Article
C2 - 37219931
AN - SCOPUS:85163148748
SN - 1090-3127
VL - 27
SP - 630
EP - 638
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 5
ER -