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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Less is more - The Finnish Prehospital Stroke Scale prospective validation.
Jyrki Ollikainen1, Pasi Jolma1, Juha-Pekka Pienimäki2
1Department of Neuroscience and Rehabilitation, Tampere University Hospital and University of Tampere, Tampere, Finland.
Summary
The Finnish Prehospital Stroke Scale (FPSS) effectively identifies large vessel occlusion strokes for immediate treatment. Paramedics can use this tool to accurately triage stroke patients, improving outcomes.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Acute stroke care pathways require prehospital identification of large vessel occlusion (LVO).
- The Finnish Prehospital Stroke Scale (FPSS) was developed to differentiate general stroke from LVO.
- FPSS has a simple design for paramedics and statistical advantages.
Purpose of the Study:
- To implement and evaluate the FPSS-based Western Finland Stroke Triage Plan.
- To assess the accuracy of FPSS in identifying LVO in prehospital settings.
Main Methods:
- A prospective study of consecutive recanalization candidates within six months of implementing the triage plan.
- Cohort 1: 302 patients transported from a comprehensive stroke center hospital district.
- Cohort 2: 10 patients transferred directly from primary stroke centers.
Main Results:
- In Cohort 1, FPSS showed 0.66 sensitivity and 0.94 specificity for LVO.
- Positive predictive value was 0.70, and negative predictive value was 0.93.
- In Cohort 2, 9 out of 10 patients had LVO; one had intracerebral hemorrhage.
Conclusions:
- FPSS is suitable for primary care services to identify candidates for endovascular treatment and thrombolysis.
- Paramedic use of FPSS predicted two-thirds of LVO cases with high specificity and PPV.
