Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-based stroke neurologists are mandated in the Czech Republic as triage and prenotification tool in acute stroke patients. The main aim of this study was to analyze the efficacy as well as quality of such teleconsultations in daily clinical practice. Methods: This is a descriptive analysis of teleconsultations between EMS paramedic crews and hospital-based neurologists in a geographically defined region of the Czech Republic (Moravian-Silesian region) between October 2018 to December 2018. All teleconsultations were analyzed for length and content. Content analysis included the following information: date, age, sex, prehospital neurological deficit(s), known/unknown time of symptom onset, anticoagulation status, vital signs, premorbid disability, and patient ID/insurance company number. Results: Within the study period, paramedics conducted 522 calls across 6 stroke centers. Of these, 334 (64%) calls were conducted because patients met pre-established prehospital criteria for suspected acute stroke. Median call duration was 1 min 44 s ± 56 s (minimum 50 s, maximum 5 min 5 s). Amongst the analyzed prehospital teleconsultations, stroke onset time was reported in 95% of cases, neurological deficit in 96%, significant co-morbidities in 53%, premorbid disability in 37%, and anticoagulation status in 53%. Conclusion: Teleconsultations between paramedics and hospital-based neurologists are not time-consuming. Stroke onset time and severity of neurological deficit are consistently communicated, however other important information such as comorbidities, premorbid disability, and anticoagulation status are reported inconsistently.
- Publikační typ
- časopisecké články MeSH
Background and Purpose: Ischemic stroke is a leading cause of mortality and morbidity worldwide. The time from stroke onset to treatment impacts clinical outcome. Here, we examined whether changing a triage model from "drip and ship" to "mothership" yielded significant reductions of onset-to-groin time (OGT) in patients receiving EVT and onset-to-needle time (ONT) in IVT-treated patients, compared to before FAST-PLUS test implementation. We also investigated whether the new triage improved clinical outcomes. Methods: In a before/after multicenter study, we evaluated the effects of changing the prehospital triage system for suspected stroke patients in the Moravian-Silesian region, Czech Republic. In the new system, the validated FAST PLUS test is used to differentiate patients with suspected large vessel occlusion and triage-positive patients are transported directly to the CSC. Time metrics and patient data were obtained from the regional EMS database and SITS database. Results: For EVT patients, the median OGT was 213 min in 2015 and 142 min in 2018, and the median TT was 142 min in 2015 and 47 min in 2018. For tPA patients, the median ONT was 110 min in 2015 and 109 min in 2018, and the median TT was 41 min in 2015 and 48 min in 2018. Clinical outcome did not significantly change. The percentages of patients with favorable clinical outcome (mRS 0-2) were comparable between 2015 and 2018: 60 vs. 59% in tPA patients and 40 vs. 44% in EVT patients. Conclusions: The new prehospital triage has yielded shorter OGTs for EVT patients. No changes were found in the onset-to-needle time for IVT-treated patients, or in the clinical outcome at 3 months after stroke onset.
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The purpose of the study is to verify the sensitivity of pre-hospital triage algorithm used in the Czech Republic, which decides on directing the patients at risk of a failure of vital functions into a trauma centre. Another aim is to find out whether the triage algorithm extension by items F4-persistent traumatic paralysis and M7-buried under heavy objects, implemented in 2015, resulted in an increased sensitivity of triage. MATERIAL AND METHODS It is a retrospective, observational, monocentric study. Included in the study were all the trauma patients with the National Advisory Committee on Aeronautics (NACA) score 3-6 treated in the given period, directed by the emergency medical service to the trauma centre. Two groups of patients were compared. In the first group, triage was performed in line with the Bulletin of the Ministry of Health of 2008, while in the second group it was performed in line with the updated version published in the Bulletin of the Ministry of Health in 2015. Both the groups were later compared with the Injury Severity Score (ISS) obtained after the diagnosis of injury in the Trauma Centre of the University Hospital Ostrava. In the second group, also certain selected parameters were assessed. Group A: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2013 to 31 December 2014 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2008. Group B: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2016 to 31 December 2017 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2015. In Group B, also monitored was the number of patients identified as triage positive only based on F4 and M7. RESULTS The first group included 3,475 patients, of whom 435 were triage positive. In the respective period, the Trauma Centre of the University Hospital Ostrava identified 262 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 210 patients. 19.9% were false negative (52/262). The mean ISS was 33.1±9.4, median 34, IQR 25.5--1. In Group A, the sensitivity of triage criteria reached 80.2% (95% IS: 74.7-84.7%), the specificity was 93.0% (95% IS: 92.0-93.8%). The second group included 3,816 patients, of whom 586 were triage positive. In the monitored period, the Trauma Centre of the University Hospital Ostrava identified 363 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 313 patients. 13.8% were false negative (50/363). The mean ISS was 43.7±12.0, median 42, IQR 33-54. In Group B, the sensitivity of triage criteria reached 86.2% (95% IS: 82.1-89.5%), the specificity was 98.5% (95% IS: 97.9-98.8%). In Group B, 11 patients were identified as triage positive based on F4 and M7 items. No statistically significant difference was found (chi-squared test, p = 0.257) after adding the F4 and M7 items to the algorithm. CONCLUSIONS The triage system for pre-hospital care in the Czech Republic in line with the applicable pre-hospital triage has high sensitivity as well as specificity and the results correspond to the latest triage algorithms used abroad. Increased sensitivity as a result of adding the new triage items was not confirmed. Key words: pre-hospital triage.
- MeSH
- algoritmy MeSH
- lidé MeSH
- rány a poranění diagnóza terapie MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- skóre závažnosti úrazu * MeSH
- traumatologická centra organizace a řízení normy MeSH
- třídění pacientů metody normy MeSH
- urgentní zdravotnické služby metody normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- validační studie MeSH
- Geografické názvy
- Česká republika MeSH
Cíl: Třídění pacientů záchranáři v přednemocniční péči by mohlo určit, kteří pacienti budou přímo transportováni do komplexního cerebrovaskulárního centra k provedení mechanické trombektomie. Aby třídění bylo úspěšné, zdravotničtí záchranáři musí být schopni identifikovat závažné neurologické postižení. Cílem naší studie bylo stanovit míru shody inter-rater reability mezi záchranáři a neurology - specialisty na CMP, při identifikaci těžké hemiparézy u pacientů s akutní CMP. Metodika: V prospektivní multicentrické studii bylo využito elektronické formy výuky u 225 záchranářů Zdravotnické záchranné služby tak, aby byli schopni rozlišit lehkou a těžkou hemiparézu. Ke stanovení míry shody mezi záchranáři a neurology - specialisty na CMP v hodnocení stupně závažnosti hemiparézy (National Institutes of Health Stroke Scale [NIHSS], body 5 a 6, skóre 0-2 [žádná nebo lehká] vs. 3-4 [těžká]) byl využit nevázaný index kappa;. Výsledky: Během 10 měsíců v roce 2016 bylo v přednemocniční neodkladné péči zdravotnickými záchranáři vyšetřeno na přítomnost hemiparézy 402 pacientů (průměrný věk 75 let), kteří byli současně ihned po přijetí do iktového centra vyšetřeni také neurology - specialisty na CMP. Celková shoda mezi záchranáři a neurology při hodnocení těžké hemiparézy nebo monoparézy byla mírná: kappa 0,43 (95% CI 0,36-0,50). Závěr: V hodnocení záchranářů v přednemocniční neodkladné péči byla zjištěna mírná reprodukovatelnost identifikace těžké hemiparézy u pacientů s akutní CMP. Před zavedením změn ve směrování na základě posouzení závažnosti neurologického deficitu je zapotřebí lepšího systému vzdělávání pro záchranáře.
Aim: Pre-hospital triage by paramedics could determine which patients qualify for direct transport to comprehensive stroke centres for mechanical thrombectomy. For triage to be successful, paramedics have to be able to identify major neurological impairments. The aim of our study was to determine inter-rater reliability between paramedics and stroke neurologists in identifying severe hemiparesis in acute stroke patients. Methods: In this prospective, multicentre study, 225 paramedics from Emergency Medical Services were taught via e-learning to distinguish between mild and severe hemiparesis. Inter-rater agreement between paramedics and stroke specialists in evaluating the degree of hemiparesis (National Institutes of Health Stroke Scale [NIHSS], items 5 and 6, scoring 0-2 [none or mild] vs. 3-4 [severe]) was assessed using the unweighted kappa; index. Results: Over the course of 10 months in 2016, 402 consecutive patients (average age 75 years) were evaluated for the presence of hemiparesis by paramedics during pre-hospital care and by stroke neurologists immediately after stroke centre admission. The total agreement between the paramedics and neurologists in their evaluations of severe hemiparesis or monoparesis was moderate: kappa; 0.43 (95% CI 0.36-0.50). Conclusion: We found moderate reproducibility of the identification of severe hemiparesis in acute stroke patients when assessed by paramedics in a pre-hospital setting. Better education for paramedics is needed before implementing a change in transport triage based on their assessment of severity of neurological deficit.
ÚVOD: Těžké trauma vede k porušení zevních i vnitřních bariérových systémů postiženého organizmu s následnou komplexní a velmi provázanou reakcí, která je spouštěna uvolněním signálních molekul z poškozených tkání. Tyto iniciují jak aktivaci vrozeného imunitního systému, tak i stimulaci získané imunity a ovlivnění systému nervového a hormonálního. Snahou organizmu je udržet rovnováhu a přiměřenost této složité reakce a zabránit nadměrné eskalaci původně protektivních fyziologických dějů. CÍL: Cílem práce je poskytnout ucelený pohled na komplexní problematiku následných změn organizmu po těžkém traumatu. METODOLOGIE: Přehledový článek. ZÁVĚR: Stále podrobnější znalosti a metody odhalování patofyziologických procesů organizmu v souvislosti s těžkým traumatem mohou být klíčem dalších možných terapeutických intervencí u těchto zraněných.
- MeSH
- imunitní systém - jevy fyziologie MeSH
- lidé MeSH
- neurosekreční systémy fyziologie MeSH
- rány a poranění * metabolismus patofyziologie MeSH
- šok metabolismus patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is indicated for the treatment of large vessel occlusion (LVO) stroke. MT should be provided as quickly as possible; therefore, a test identifying suspected LVO in the prehospitalization stage is needed to ensure direct transport to a comprehensive stroke center (CSC). We assume that patients with clinically severe hemiparesis have a high probability of LVO stroke. We modified the FAST test into the FAST PLUS test: The first part is the FAST test and the second part evaluates the presence of severe arm or leg motor deficit. This prospective multicenter study evaluates the specificity and sensitivity of the FAST PLUS test in detecting LVO stroke. METHODS: Paramedics were trained through e-learning to conduct the FAST PLUS test. All prehospital suspected stroke patients who were administered the FAST PLUS test were included. Demographics, National Institutes of Health Stroke Scale (NIHSS) score, brain computed tomography (CT), and CT angiography (CTA) were recorded. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating curve (ROC) area for LVO were calculated. RESULTS: The study included 435 patients. LVO were found in 124 patients (28%). Sensitivity was 93%, specificity was 47%, PPV was 41%, NPV was 94%, and ROC area for ICA/MCA occlusion was 0.65. Intracerebral hemorrhage (ICH) was identified in 48 patients (11%). CONCLUSION: We found that the FAST PLUS test had a high sensitivity for LVO stroke. Of the 435 patients, 41% were all directly transported to a CSC based on positive FAST PLUS test scores and were potential candidates for MT.
- MeSH
- arteriální okluzní nemoci diagnóza etiologie patofyziologie MeSH
- bérec patofyziologie MeSH
- cévní mozková příhoda komplikace diagnóza patofyziologie MeSH
- CT angiografie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mozek diagnostické zobrazování patofyziologie MeSH
- obličej patofyziologie MeSH
- paréza diagnóza etiologie patofyziologie MeSH
- paže patofyziologie MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- urgentní zdravotnické služby metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
INTRODUCTION: Severe trauma leads to a disruption of the external and internal barrier systems of the affected organism followed by a complex and highly organized reaction triggered by the release of signal molecules from the damaged tissues. These initiate both the activation of the innate immune system and the stimulation of acquired immunity and affect the nervous and hormonal systems. The effort of the organism is to maintain balance and adequacy of this complex reaction and to prevent excessive escalation of originally protective physiological processes. OBJECTIVE: The aim of this work is to provide a comprehensive view of the complex issue of subsequent changes in the body after a severe trauma METHODOLOGY: Review article. CONCLUSION: More and more detailed knowledge and methods of detecting the pathophysiological processes of the body in connection with severe trauma may be the key to other possible therapeutic interventions for these injured patients.
- MeSH
- imunitní systém - jevy fyziologie MeSH
- lidé MeSH
- neurosekreční systémy fyziologie MeSH
- rány a poranění * metabolismus patofyziologie MeSH
- šok metabolismus patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
