Evidence map›Paper›PMID 26265130›Full record

ArticleStroke2015

Routing Ambulances to Designated Centers Increases Access to Stroke Center Care and Enrollment in Prehospital Research.

Nerses Sanossian, David S Liebeskind, Marc Eckstein, Sidney Starkman, Samuel Stratton, Franklin D Pratt, William Koenig, Scott Hamilton, May Kim-Tenser, Robin Conwit and 2 more

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00059332 (Field Administration of Stroke Therapy-Magnesium Trial), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00059332 phase3completednot on this map

Field Administration of Stroke Therapy-Magnesium Trial: A Randomized, Double-Blind, Placebo Controlled Trial of Neuroprotective Magnesium Sulfate Therapy for Acute Stroke Initiated Within 2 Hours of Onset by Paramedics in the Field

TypeinterventionalSponsorJeffrey L. SaverRan2005 to 2013Enrolled1,700ConditionsCerebrovascular AccidentArmsMagnesium Sulfate, Normal Saline
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Reliability and performance of the Swiss Emergency Triage Scale used by paramedics.European journal of emergency medicine : official journal of the European Society for Emergency Medicine · 2019
    Article
  6. Emergency medical services for acute ischemic stroke: Hub-and-spoke model versus exclusive care in comprehensive centers.Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2019
    Article
  7. Prehospital Management of Acute Stroke in Rural versus Urban Responders.Journal of neurosciences in rural practice · 2017
    Article
  8. Availability of endovascular therapies for cerebrovascular disease at primary stroke centers.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2017
    Article
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 2 institutions in 1 country.

Nerses SanossianFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.). sanossia@yahoo.com.
David S LiebeskindFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Marc EcksteinFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Sidney StarkmanFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Samuel StrattonFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Franklin D PrattFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
William KoenigFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Scott HamiltonFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
May Kim-TenserFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Robin ConwitFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
Jeffrey L SaverFrom the Departments of Neurology (N.S., M.K.-T.) and Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology and Stroke Center (D.S.L., S. Starkman, J.L.S.), and School of Public Health (S. Stratton), University of California Los Angeles; Los Angeles County Fire Department, CA (F.D.P.); Los Angeles County Emergency Medical Services Agency, CA (W.K.); School of Medicine, Stanford University, Palo Alto, CA (S.H.); and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.C.).
FAST-MAG Investigators and Coordinators
Stanford University · USUniversity of Southern California · US

Funding

Field Administration of Stroke Therapy-Magnesium Trial (FAST-MAG)U01NS044364 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SAVER, JEFFREY L · 2003 to 2013
$46.4M
NINDS NIH HHS U01 NS044364NINDS NIH HHS U01 NS 44364
6 · The paper itself

Abstract

background and purposeEmergency medical services routing of patients with acute stroke to designated centers may increase the proportion of patients receiving care at facilities meeting national standards and augment recruitment for prehospital stroke research.

methodsWe analyzed consecutive patients enrolled within 2 hours of symptom onset in a prehospital stroke trial, before and after regional Los Angeles County Emergency Medical Services implementation of preferentially routing patients with acute stroke to approved stroke centers (ASCs). From January 2005 to mid-November 2009, patients were transported to the nearest emergency department, whereas from mid-November 2009 to December 2012, patients were preferentially transported to first 9, and eventually 29, ASCs.

resultsThere were 863 subjects enrolled before and 764 after emergency medical service preferential routing, with implementation leading to an increase in the proportion cared for at an ASC from 10% to 91% (P<0.0001), with a slight decrease in paramedic on-scene to emergency department arrival time (34.5 [SD, 9.1] minutes versus 33.5 [SD, 10.3] minutes; P=0.045). The effects of routing were immediate and included an increase in proportion of receiving ASC care (from 17% to 88%; P<0.001) and a greater number of enrollments (18.6% increase) when comparing 12 months before and after regional stroke system implementation.

conclusionsThe establishment of a regionalized emergency medical services system of acute stroke care dramatically increased the proportion of patients with acute stroke cared for at ASCs, from 1 in 10 to >9 in 10, with no clinically significant increase in prehospital care times and enhanced recruitment of patients into a prehospital treatment trial. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.

Indexed as

Ambulance DiversionHospitals, SpecialThrombolytic TherapyAgedAged, 80 and overAmbulancesBiomedical ResearchBrain IschemiaCerebral HemorrhageCohort StudiesEmergency Medical ServicesEmergency Service, HospitalFemaleHealth Services AccessibilityHumansMaleemergency medical servicesemergency service, hospitalprehospital emergency carestroketriage

Identifiers

PMID26265130
PMCPMC4920547
OpenAlexW2124548874

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.