Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 7, 2020

Telemedicine-Based Prehospital Stroke Triage Speeds Thrombectomy

But if you don't know how fast thrombectomy has to occur to get 100% recovery this really doesn't help.  My definition of success is 100% recovery, NOTHING LESS! Wrong measurement.

Telemedicine-Based Prehospital Stroke Triage Speeds Thrombectomy

— Stockholm sees success??? with teleconsultation

A mature couple having online consultation with female physician at home on digital tablet
Stockholm's new prehospital stroke triage system allowed centers to deliver endovascular thrombectomy (EVT) to the right patients faster and without sacrificing time to IV thrombolysis, according to a report.
Under this system, patients were transported directly to a comprehensive stroke center (CSC) with EVT capabilities under two conditions: if they displayed moderate-to-severe hemiparesis on the A2L2 test and were accepted following teleconsultation with the CSC. Thus, select patients could bypass primary stroke centers (PSCs) that did not offer thrombectomy.
Predictive performance of this triage system was good the first year it was implemented, Michael Mazya, MD, PhD, of Karolinska University Hospital-Solna, Stockholm, and colleagues reported in a paper published online in JAMA Neurology.
Accuracy was 87% for the identification of large artery occlusion stroke and 91% for predicting EVT initiation. Positive predictive values were 41% and 26%, respectively, while negative predictive values were 93% and 99%.
Moreover, the 323 triage-positive stroke patients in the study received timely treatment when compared to historical controls from the previous year, when people were still being sent to the nearest stroke center:
  • Median onset-to-puncture time was 137 minutes vs 206 minutes (P<0.001)
  • Median onset-to-needle time was unchanged at 115 minutes
  • Median CSC IV thrombolysis door-to-needle time was 13 minutes vs 31 minutes (P<0.001)
"The Stockholm Stroke Triage System, which combines symptom severity and teleconsultation, results in markedly faster EVT delivery without delaying IV thrombolysis," Mazya's group concluded.
This new patient selection strategy thus represents a new way to answer the question of where to send a potential candidate for stroke thrombectomy. Other options include mobile stroke units, scale-based triage, "drip-and-ship," and CSC mothership, according to Anne Alexandrov, PhD, RN, of the University of Tennessee Health Science Center in Memphis, and Klaus Fassbender, MD, of Saarland University Medical Center in Homburg, Germany.
"It remains to be determined which patient selection strategy ... will be most effective. This question may be answered differently in various regions and various health care environments," they wrote in an accompanying editorial.
The new triage system, implemented in routine practice in October 2017, covered the Stockholm region, an urban area with 2.3 million inhabitants. The region was served by one CSC and six PSCs, study authors noted.
Their population-based prospective cohort study was conducted across Sweden from October 2017 to October 2018.
Of the 2,905 patients transported by priority "code-stroke" ambulance to a hospital for suspected acute stroke during this period, 11% were triage-positive for direct transport to CSCs under the new system (median age 73 years, 48% women).
Triage-positive patients were slightly younger, presented with higher stroke severity, and had lower onset-to-first-hospital-door times compared with triage-negative individuals.
EVT was performed in 26% with triage-positive results and 1.4% with triage-negative results.
The study's findings may not be generalizable to locations outside Stockholm, cautioned Mazya and colleagues.
This was illustrated by the fact that due to local practices, PSCs considered 46.6% of patients with acute ischemic stroke to be large-vessel occlusion (LVO)-negative without confirmation by vascular imaging, according to Alexandrov and Fassbender.
"We recommend validation of our system's predictive accuracy for large-artery occlusion and EVT also in settings with other criteria for routine vessel imaging and EVT treatment," Mazya's group urged.
Another limitation of the study was its before-after design, Alexandrov and Fassbender said. "Time-related factors, such as better awareness about stroke or improved performance of EMS and hospital teams over the study period, could be confounding factors that may have affected the study's results," they suggested.

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