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{
    "pk": 12616,
    "title": "Challenges Related to the Implementation of an EMS-Administered, Large Vessel Occlusion Stroke Score",
    "subtitle": null,
    "abstract": "Introduction:\n There is considerable interest in triaging victims of large vessel occlusion (LVO) strokes to comprehensive stroke centers. Timely access to interventional therapy has been linked to improved stroke outcomes. Accurate triage depends upon the use of a validated screening tool in addition to several emergency medical system (EMS)-specific factors. This study examines the integration of a modified Rapid Arterial oCcclusion Evaluation (mRACE) score into an existing stroke treatment protocol.\nMethods:\n We performed a retrospective review of EMS and hospital charts of patients transported to a single comprehensive stroke center. Adult patients with an EMS provider impression of “stroke/TIA,” “CVA,” or “neurological problem” were included for analysis. EMS protocols mandated the use of the Cincinnati Prehospital Stroke Score (CPSS). The novel protocol authorized the use of the mRACE score to identify candidates for triage directly to the comprehensive stroke center. We calculated specificity and sensitivity for various stroke screens (CPSS and a mRACE exam) for the detection of LVO stroke. The score’s metrics were evaluated as a surrogate marker for a successful EMS triage protocol.\nResults:\n We included 312 prehospital charts in the final analysis. The CPSS score exhibited reliable sensitivity at 85%. Specificity of CPSS for an LVO was calculated at 73%. For an mRACE score of five or greater, the sensitivity was 25%. Specificity for mRACE was calculated at 75%. The positive predictive value of the mRACE score for an LVO was estimated at 12.50%.\nConclusion:\n In this retrospective study of patients triaged to a single comprehensive stroke center, the addition of an LVO-specific screening tool failed to improve accuracy. Reliable triage of LVO strokes in the prehospital setting is a challenging task. In addition to statistical performance of a particular stroke score, a successful EMS protocol should consider system-based factors such as provider education and training. Study limitations can inform future iterations of LVO triage protocols.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Emergency Medical Services",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3x85r2xw",
    "frozenauthors": [
        {
            "first_name": "Benjamin",
            "middle_name": "J.",
            "last_name": "Lawner",
            "name_suffix": "",
            "institution": "Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania\nTemple University School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Kelly",
            "middle_name": "",
            "last_name": "Szabo",
            "name_suffix": "",
            "institution": "Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Jonathan",
            "middle_name": "",
            "last_name": "Daly",
            "name_suffix": "",
            "institution": "Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Krista",
            "middle_name": "M.",
            "last_name": "Foster",
            "name_suffix": "",
            "institution": "University of Pittsburgh, Joseph M Katz Graduate School of Business, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Philip",
            "middle_name": "",
            "last_name": "McCoy",
            "name_suffix": "",
            "institution": "Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "",
            "last_name": "Poliner",
            "name_suffix": "",
            "institution": "Penn Medicine, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Matthew",
            "middle_name": "",
            "last_name": "Poremba",
            "name_suffix": "",
            "institution": "Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania\nTemple University School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Philip",
            "middle_name": "S.",
            "last_name": "Nawrocki",
            "name_suffix": "",
            "institution": "Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Rahul",
            "middle_name": "",
            "last_name": "Rahangdale",
            "name_suffix": "",
            "institution": "University of Minnesota School of Medicine, Department of Neurology, Minneapolis, Minnesota",
            "department": "None"
        }
    ],
    "date_submitted": "2019-04-11T22:13:07+05:30",
    "date_accepted": "2019-04-11T22:13:07+05:30",
    "date_published": "2020-01-18T02:02:41+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/12616/galley/6682/download/"
        }
    ]
}