ArticleStroke2020
Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States.
Article in Stroke, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Mothership Versus Drip-and-Ship Models in Acute Stroke Care: A Time-Sensitive Meta-Analysis.Journal of the American Heart Association · 2026Pooled it
- Artificial Intelligence for Large-Vessel Occlusion Stroke: A Systematic Review.World neurosurgery · 2022Pooled it
- Article
- Inclusion of Hospital Performance in Prehospital Stroke Routing: A Simulation Study.Prehospital emergency care · 2026Article
- Use of artificial intelligence in the out-of-hospital care settings: a scoping review.BMJ digital health & AI · 2026Article
- Bayesian modeling framework for optimizing pre-hospital stroke triage decisions.Journal of applied statistics · 2025Article
- Machine Learning-Enabled Automated Large Vessel Occlusion Detection Improves Transfer Times at Primary Stroke Centers.Stroke (Hoboken, N.J.) · 2024Article
- Geographical Requirements for the Applicability of the Results of the RACECAT Study to Other Stroke Networks.Journal of the American Heart Association · 2023Article
- Intravenous Thrombolysis Is Associated With Better Outcomes in Large-Vessel Occlusion Requiring Endovascular Therapy.Stroke (Hoboken, N.J.) · 2023Article
- Quality metrics in the management of acute stroke in Greece during the first 5 years of Registry of Stroke Care Quality (RES-Q) implementation.European stroke journal · 2023Article
- Article
- Performance of the vision, aphasia, neglect (VAN) assessment within a single large EMS system.Journal of neurointerventional surgery · 2022Article
- The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches.Journal of clinical medicine · 2022Review
- National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study.European stroke journal · 2022Article
- Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries.Circulation. Cardiovascular quality and outcomes · 2022Article
- Influence of hospital capabilities and prehospital time on outcomes of thrombectomy for stroke in Japan from 2013 to 2016.Scientific reports · 2022Observational
- Large vessel occlusion prediction scales provide high negative but low positive predictive values in prehospital suspected stroke patients.BMJ neurology open · 2022Article
- Large Vessel Occlusion Stroke Detection in the Prehospital Environment.Current emergency and hospital medicine reports · 2021Article
- Article
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
Abstract
background and purposeIschemic stroke patients with large vessel occlusion (LVO) could benefit from direct transportation to an intervention center for endovascular treatment, but non-LVO patients need rapid IV thrombolysis in the nearest center. Our aim was to evaluate prehospital triage strategies for suspected stroke patients in the United States.
methodsWe used a decision tree model and geographic information system to estimate outcome of suspected stroke patients transported by ambulance within 4.5 hours after symptom onset. We compared the following strategies: (1) Always to nearest center, (2) American Heart Association algorithm (ie, directly to intervention center if a prehospital stroke scale suggests LVO and total driving time from scene to intervention center is <30 minutes, provided that the delay would not exclude from thrombolysis), (3) modified algorithms with a maximum additional driving time to the intervention center of <30 minutes, <60 minutes, or without time limit, and (4) always to intervention center. Primary outcome was the annual number of good outcomes, defined as modified Rankin Scale score of 0-2. The preferred strategy was the one that resulted in the best outcomes with an incremental number needed to transport to intervention center (NNTI) <100 to prevent one death or severe disability (modified Rankin Scale score of >2).
resultsNationwide implementation of the American Heart Association algorithm increased the number of good outcomes by 594 (+1.0%) compared with transportation to the nearest center. The associated number of non-LVO patients transported to the intervention center was 16 714 (NNTI 28). The modified algorithms yielded an increase of 1013 (+1.8%) to 1369 (+2.4%) good outcomes, with a NNTI varying between 28 and 32. The algorithm without time limit was preferred in the majority of states (n=32 [65%]), followed by the algorithm with <60 minutes delay (n=10 [20%]). Tailoring policies at county-level slightly reduced the total number of transportations to the intervention center (NNTI 31).
conclusionsPrehospital triage strategies can greatly improve outcomes of the ischemic stroke population in the United States, but increase the number of non-LVO stroke patients transported to an intervention center. The current American Heart Association algorithm is suboptimal as a nationwide policy and should be modified to allow more delay when directly transporting LVO-suspected patients to an intervention center.
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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.