My conclusion is that this was bad research, you didn't measure recovery at all. I think survivors would like to know how good you were at getting survivors recovered, this is a failing grade and you should be fired.
“What's measured, improves.” So said management legend and author Peter F. Drucker
The latest here:
Impact of prehospital stroke triage implementation on patients with intracerebral hemorrhage
Abstract
Background:
Little
is known about how prehospital triage using large vessel occlusion
(LVO) stroke prediction scales affects patients with intracerebral
hemorrhage (ICH).
Objectives:
We
aimed to investigate whether the Stockholm Stroke Triage System (SSTS)
implemented in 2017 has affected timing and outcomes of acute ICH
neurosurgery, and to assess system triage accuracy for ICH with a
neurosurgical indication or LVO thrombectomy.
Design:
Observational cohort study.
Methods:
In
the Stockholm Region, we compared surgical timing, functional outcome,
and death at 3 months in patients transported by code-stroke ground
ambulance who had ICH neurosurgery, 2 years before versus 2 years
after SSTS implementation. We also calculated triage precision metrics
for treatment with either ICH neurosurgery or thrombectomy.
Results:
A
total of 36 patients undergoing ICH neurosurgery were included before
SSTS implementation and 30 after. No significant difference was found in
timing of neurosurgery [median 7.5 (4.9–20.7) versus 9.1 (6.1–12.5) h after onset], distribution of functional outcomes (median 4 versus 4), and death at 3 months [3/29 (9%) versus 5/35 (17%)] before versus
after implementation, respectively. The SSTS routed a larger proportion
of patients subsequently undergoing ICH neurosurgery directly to the
comprehensive stroke center: 13/36 (36%) before versus 18/30
(60%) after implementation. Overall system triage accuracy for ICH
neurosurgery or thrombectomy was high at 90%, with 92% specificity and
65% sensitivity.
Conclusion:
The
SSTS, initially designed for prehospital LVO stroke triage, routed more
patients with neurosurgical indication for ICH directly to the
comprehensive stroke center. This did not significantly affect surgical
timing or outcomes.
Introduction
Recently
updated intracerebral hemorrhage (ICH) guidelines from the American
Heart Association/American Stroke Association recommend prehospital
tools to recognize stroke and grade its severity.1
Meanwhile, studies of prehospital severity-based algorithms on ICH are
lacking. This is highlighted in the guidelines, which emphasize the need
for research on the impact of regionalized large vessel occlusion (LVO)
stroke pathways on ICH patients.1
Comprehensive stroke centers (CSCs) receive a larger proportion of ICH
patients after implementation of prehospital LVO protocols, owing to
higher symptom severity in ICH compared with ischemic stroke and stroke
mimics.1–3
Avoiding interhospital transfers in ICH has been reported to reduce the
risk of deterioration during transport and decrease costs.4–6
It is yet unknown whether symptom-based prehospital triage of patients
to a CSC leads to more rapid initiation of ICH treatments only available
at CSCs, specifically acute neurosurgery.
In
2017, the Stockholm Region implemented the Stockholm Stroke Triage
System (SSTS), aiming to identify patients with LVO stroke and transport
them directly to the CSC, bypassing more proximal primary stroke
centers (PSCs). The SSTS reduced time from onset to endovascular
thrombectomy (EVT) by 69 min without delaying intravenous thrombolysis
(IVT), and significantly improved outcomes in EVT.7,8
Of nearly 3000 patients annually taken to hospital by code-stroke
ambulance in the Stockholm Region, 8% have previously been shown to
suffer from ICH, 4% a subarachnoid or subdural hemorrhage, 44% an
ischemic stroke or transient ischemic attack, and 44% a stroke mimic.9
First,
we aimed to evaluate whether timing and outcome of acute ICH
neurosurgery changed after SSTS implementation. Second, we aimed to
expand previous results on SSTS accuracy for identification of patients
needing EVT, by investigating the system’s accuracy for patients
requiring either EVT or acute ICH neurosurgery, and assess differences
between triage-positive and triage-negative ICH patients.
More at link.
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