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VNA of Care New England

Prehospital Triage Policy for Suspected Stroke Ups tPA Use

Implementation of a prehospital stroke triage policy also ups use of emergency medical services
MONDAY, July 1 (HealthDay News) -- Implementation of a prehospital triage policy for patients with suspected stroke is associated with increased use of intravenous (IV) tissue plasminogen activator (tPA), according to a study published online July 1 in JAMA Neurology.
Shyam Prabhakaran, M.D., from Northwestern University in Chicago, and colleagues conducted a retrospective multicenter cohort study to examine the impact of a citywide policy recommending prehospital triage of patients with suspected stroke to the nearest primary stroke center on use of IV tPA. Use of IV tPA was compared for six months before and after policy implementation.
In the pre- and post-triage periods, the researchers identified 1,075 and 1,172 stroke and transient ischemic attack admissions, respectively. After implementation of the policy, there were significant increases in the use of emergency medical services and emergency medical services prenotification, compared with the pre-triage period. The rates of IV tPA use increased significantly, from 3.8 to 10.1 percent pre- and post-triage, respectively. Onset-to-treatment times decreased significantly, from 171.7 minutes in the pre-triage period to 145.7 minutes in the post-triage period. For patients with ischemic stroke presenting through the emergency department, the post-triage period was independently associated with increased tPA use, after adjustment for mode of arrival, prehospital notification, and onset-to-arrival time (adjusted odds ratio, 2.21).
"A citywide stroke system of care that includes a preferential triage policy and paramedic and public education can have a significant, immediate, sustainable impact on IV tPA use," the authors write. "Our results provide further evidence to support the development of primary stroke centers and regional strategies to direct patients with stroke to them."
One author disclosed financial ties to Genentech.
Abstract (http://archneur.jamanetwork.com/article.aspx?articleid=1704352#Abstract )Full Text (subscription or payment may be required) (http://archneur.jamanetwork.com/article.aspx?articleid=1704352 )
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