Pre-hospital Diagnosis of Large Vessel Occlusion in Patients Being Transported by Helicopter |
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| Authors: | Yusuke Sugimura Tokunori Ikeda Seigo Shindo Satoshi Namitome Masatomo Miura Kuniyasu Wada Yoichiro Nagao Yoshinori Yamanouchi Tadashi Terasaki Makoto Nakajima |
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| Affiliation: | 2. Department of Clinical Investigation, Kumamoto University Hospital, 1-1-1 honjyo, Chuo-ku, Kumamoto, 860-8556 Japan;3. Department of Neurology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine, Higashi-ku, Kumamoto, 861-8520 Japan;4. Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 honjyo, Chuo-ku, Kumamoto, 860-8556 Japan;2. Department of Emergency, Nissan Tamagawa Hospital, Setagaya, Tokyo, Japan;3. Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan;4. Department of Clinical Laboratory Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan;2. Department of Emergency Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea;3. Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea;4. Department of Emergency Medicine, Incheon St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea;2. Department of Neurology, Air Force Medical Center, 30 Fucheng Road, Haidian District, Beijing 100142, P.R. China;2. Division of Radiology, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan;2. Neurology Department, Headache and Neurosonology Unit, Università Campus Bio-Medico di Roma, Italy;3. Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy;4. Department of Pathology, Università Campus Bio-Medico di Roma, Italy;2. Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland;3. School of Biomedical Engineering and Imaging Sciences, King''s College, London, United Kingdom;4. Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Greece;5. Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, United Kingdom |
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| Abstract: | BackgroundDuring the helicopter transportation of patients suspected of large vessel occlusion (LVO), an accurate and rapid decision-making process is required.AimsWe attempted to create an algorithm for the pre-hospital diagnosis of the presence of LVO in patients suspected of stroke using data from patients transported urgently by helicopter.MethodsOne hundred and sixty-five patients transported by helicopter were divided into two subgroups: a training dataset and a validation dataset. We extracted clinical information obtained on site, the unadjusted score of the National Institutes of Health Stroke Scale, and previously reported pre-hospital scales as an LVO screen. On the basis of the analyses of these factors, an algorithm was devised to predict the presence of LVO and its predictive accuracy was evaluated using the validation dataset.ResultsIschemic stroke with LVO was diagnosed in 36 out of 121 cases (29.8%) in the training dataset and in 10 out of 44 cases (22.7%) in the validation dataset. Combining five factors (conjugate deviation, upper limb paresis, atrial fibrillation, Japan Coma Scale ≥ 200, and systolic blood pressure ≥ 180), an algorithm was created to classify cases into six groups with different likelihoods of LVO presence. The algorithm predicted correctly 6 out of 10 cases in the validation dataset. Furthermore, it definitively ruled out 17 out of 34 cases in the validation dataset.ConclusionsUsing the newly created algorithm, emergency staff could easily and accurately distinguish patients suitable for urgent endovascular thrombectomy from patients with non-LVO or stroke mimics. |
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