Abstract:
OBJECTIVE:Current prehospital scales used to detect large vessel occlusion reveal very low endovascular thrombectomy (EVT) rates among selected patients. We developed a novel prehospital scale, the Madrid-Direct Referral to Endovascular Center (M-DIRECT), to identify EVT candidates for direct transfer to EVT-capable centers (EVT-Cs). The scale evaluated clinical examination, systolic blood pressure, and age. Since March 2017, patients closer to a stroke unit without EVT capabilities and an M-DIRECT positive score have been transferred to the nearest EVT-C. To test the performance of the scale-based routing protocol, we compared its outcomes with those of a simultaneous cohort of patients directly transferred to an EVT-C. METHODS:In this prospective observational study of consecutive patients with stroke code seen by emergency medical services, we compared diagnoses, treatments, and outcomes of patients who were closer to an EVT-C (mothership cohort) with those transferred according to the M-DIRECT score (M-DIRECT cohort). RESULTS:The M-DIRECT cohort included 327 patients and the mothership cohort 214 patients. In the M-DIRECT cohort, 227 patients were negative and 100 were positive. Twenty-four (10.6%) patients required secondary transfer, leaving 124 (38%) patients from the M-DIRECT cohort admitted to an EVT-C. EVT rates were similar for patients with ischemic stroke in both cohorts (30.9% vs 31.5%). The M-DIRECT scale had 79% sensitivity, 82% specificity, and 53% positive predictive value for EVT. Recanalization and independence rates at 3 months did not differ between the cohorts. CONCLUSIONS:The M-DIRECT scale was highly accurate for EVT, with treatment rates and outcomes similar to those of a mothership paradigm, thereby avoiding EVT-C overload with a low rate of secondary transfers.
journal_name
Neurologyjournal_title
Neurologyauthors
Rodríguez-Pardo J,Riera-López N,Fuentes B,Alonso de Leciñana M,Secades-García S,Álvarez-Fraga J,Busca-Ostolaza P,Carneado-Ruiz J,Díaz-Guzmán J,Egido-Herrero J,Gil-Núñez A,Masjuan-Vallejo J,Real-Martínez V,Vivancos-Mora J,Díezdoi
10.1212/WNL.0000000000008998subject
Has Abstractpub_date
2020-02-25 00:00:00pages
e851-e860issue
8eissn
0028-3878issn
1526-632Xpii
WNL.0000000000008998journal_volume
94pub_type
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