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Lindström, V., Romanitan, M. O., Berglund, A., Pirvulescu, R. A., von Euler, M. & Bohm, K. (2024). Callers' Descriptions of Stroke Symptoms during Emergency Calls in Victims Who Have Fallen or Been Found Lying Down: A Qualitative Content Analysis. Healthcare, 12(4), Article ID 497.
Open this publication in new window or tab >>Callers' Descriptions of Stroke Symptoms during Emergency Calls in Victims Who Have Fallen or Been Found Lying Down: A Qualitative Content Analysis
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2024 (English)In: Healthcare, E-ISSN 2227-9032, Vol. 12, no 4, article id 497Article in journal (Refereed) Published
Abstract [en]

Early identification of stroke symptoms is essential. The rate of stroke identification by call-takers at emergency medical communication centres (EMCCs) varies, and patients who are found in a lying down position are often not identified as having an ongoing stroke.

OBJECTIVES: this study aimed to explore signs and symptoms of stroke in patients who had fallen or were found in a lying position. DESIGN: a retrospective exploratory qualitative study design was used.

METHOD: a total of 29 emergency calls to EMCCs regarding patients discharged with a stroke diagnosis from a large teaching hospital in Stockholm, Sweden, in January-June 2011, were analysed using qualitative content analysis. RESULTS: during the emergency calls, the callers described a sudden change in the patient's health status including signs such as the patient's loss of bodily control, the patient's perception of a change in sensory perception, and the callers' inability to communicate with the patient.

CONCLUSIONS: The callers' descriptions of stroke in a person found in a lying position are not always as described in assessment protocols describing the onset of a stroke. Instead, the symptom descriptions are much vaguer. Therefore, to increase identification of stroke during emergency calls, there is a need for an increased understanding of how callers describe stroke symptoms and communicate with the call-takers.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
Content analysis, dispatch centre, emergency call, stroke
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-111957 (URN)10.3390/healthcare12040497 (DOI)38391872 (PubMedID)
Funder
The Swedish Stroke AssociationKarolinska InstituteStockholm County Council
Note

The third author had financial support from The Swedish Stroke Association (Stroke-Riksförbundet) and Södersjukhuset, the Department of Internal Medicine. This study is a part of the Fighting Stroke Project (Uppdrag Besegra Stroke), supported by the Swedish Heart and Lung Foundation and Karolinska Institutet; the project is supported by funding from Friends of Karolinska Institutet, USA, and Johanniterorden. Financial support was provided through the Centre for Gender Medicine at Karolinska Institutet and from the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet.

Available from: 2024-02-26 Created: 2024-02-26 Last updated: 2024-02-26Bibliographically approved
Gunnarsson, K., Tofiq, a., Mathew, A., Cao, Y., von Euler, M. & Ström, J. O. (2023). Changes in stroke and TIA admissions during the COVID-19 pandemic: A meta-analysis. European Stroke Journal, Article ID 23969873231204127.
Open this publication in new window or tab >>Changes in stroke and TIA admissions during the COVID-19 pandemic: A meta-analysis
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2023 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, article id 23969873231204127Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To perform a meta-analysis on how the admissions of stroke and transient ischemic attack (TIA) changed during the Corona Virus infection-19 (COVID-19) pandemic and evaluate if the effect was depending on stroke severity.

METHODS: Observational cohort studies comparing the number of stroke and/or TIA admissions during a period of the pandemic compared to a period before the pandemic were identified in PubMed and Embase. After excluding studies with overlapping populations and studies without satisfactory case ascertainment, data was extracted and meta-analyzed.

FINDINGS: A total of 59 studies were included. During the pandemic, there was a decrease in admissions of ischemic stroke (admission rate ratio (ARR) = 0.77, 95% confidence interval (CI): 0.72, 0.82), intracerebral hemorrhage (ARR = 0.79, 95% CI: 0.70, 0.90) and TIA (ARR = 0.66, 95% CI: 0.58, 0.75). Albeit admission rates of both mild (ARR = 0.61, 95% CI: 0.49, 0.77) and severe (ARR = 0.82, 95% CI = 0.71, 0.95) strokes decreased, milder strokes decreased more (proportion ratio (PR) = 0.76, 95% CI: 0.65, 0.89).

DISCUSSION: Potential causes for the admission reduction could be strict prioritizations within the health care, patients' fear of acquiring COVID-19, or decreased access to health care due to lockdowns.

CONCLUSION: During the COVID-19 pandemic, there was a reduction in admissions of stroke and TIA, possibly caused by reluctance to seek medical care.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Acute ischemic stroke, Corona virus, NIHSS, SARS-CoV-2, TIA, cerebral infarction, intracerebral hemorrhage
National Category
Public Health, Global Health, Social Medicine and Epidemiology Neurology
Identifiers
urn:nbn:se:oru:diva-108656 (URN)10.1177/23969873231204127 (DOI)001073208700001 ()37776062 (PubMedID)2-s2.0-85173493290 (Scopus ID)
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2024-01-02Bibliographically approved
Ullberg, T., von Euler, M., Wester, P., Arnberg, F., Norrving, B., Andersson, T. & Wassélius, J. (2023). Endovascular thrombectomy for anterior circulation stroke beyond 6 hours of onset in Sweden 2015 to 2020: rates and outcomes in a nationwide register-based study. Journal of neurointerventional surgery, 15(4), 330-335
Open this publication in new window or tab >>Endovascular thrombectomy for anterior circulation stroke beyond 6 hours of onset in Sweden 2015 to 2020: rates and outcomes in a nationwide register-based study
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2023 (English)In: Journal of neurointerventional surgery, E-ISSN 1759-8486, Vol. 15, no 4, p. 330-335Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden.

METHODS: We included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015-2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (<6 hours), late window (6-24 hours) known onset, late window last seen well (LSW). Favorable outcome (modified Rankin Scale (mRS) 0-2) and all-cause mortality at 90 days were the main outcomes, and symptomatic intracerebral hemorrhage (sICH) was the safety outcome.

RESULTS: Late window EVT increased from 0.3% of all IS in 2015 to 1.8% in 2020, and from 17.4% of all anterior circulation EVTs in 2015 to 32.9% in 2020. Of 2199 patients, 76.9% (n=1690) were early window EVTs and 23.1% late window EVTs (n=509; 141 known onset, 368 LSW). Median age was 73 years, and 46.2% were female, with no differences between groups. Favorable outcome did not differ between groups (early window 42.4%, late window known onset 38.9%, late window LSW 37.3% (p=0.737)) and remained similar when adjusted for baseline differences. sICH rates did not differ (early window 4.0%, late window known onset 2.1%, late window LSW 4.9% (p=0.413)).

CONCLUSION: Late window EVTs have increased substantially over time, and currently account for one third of anterior circulation treatments. Early and late window patients had similar outcomes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
CT perfusion, Stroke, Thrombectomy, Thrombolysis
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-98156 (URN)10.1136/neurintsurg-2022-018670 (DOI)000771049800001 ()35301261 (PubMedID)2-s2.0-85150311660 (Scopus ID)
Funder
The Crafoord Foundation
Note

Funding agencies:

Regional ALF grants

SUS Stiftelser och Fonder

Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2024-01-02Bibliographically approved
Åsberg, S., Redfors, P. & von Euler, M. (2023). Förebyggande behandling efter ischemisk stroke/TIA har effekt: [Preventive treatment to avoid recurrence of stroke and TIA is effective]. Läkartidningen, 120(36-37), Article ID 23061.
Open this publication in new window or tab >>Förebyggande behandling efter ischemisk stroke/TIA har effekt: [Preventive treatment to avoid recurrence of stroke and TIA is effective]
2023 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, no 36-37, article id 23061Article in journal (Refereed) Published
Abstract [sv]

Sekundärprevention efter stroke/TIA inleds ofta i akutskedet och är effektiv för att undvika återinsjuknande.

Goda levnadsvanor (dvs fysisk aktivitet efter förmåga, rökfrihet, hälsosam diet och lågriskkonsumtion av alkohol) spelar en viktig roll vid prevention av stroke.

Val av sekundärprevention styrs av vilken typ av stroke/TIA som inträffat och dess bakomliggande orsak.

Kirurgisk strokeprevention kan vara aktuell, till exempel vid symtomgivande signifikant karotisstenos eller öppetstående foramen ovale vid kryptogen stroke.

Artikeln beskriver standardiserad sekundär strokeprevention enligt Socialstyrelsens riktlinjer, men också när förebyggande behandling behöver individanpassas.

Abstract [en]

Healthy living with physical activity, healthy eating habits, no smoking, and no alcohol overuse have an important role in primary and secondary stroke prevention. Further secondary prevention depends on type and cause of stroke or TIA. After intracerebral bleeding, ischemic stroke or TIA, preventive pharmacological therapies include antihypertensive drugs. After ischemic stroke or TIA, treatment with antithrombotics (oral anticoagulants or antiplatelets) and statins is recommended. In stroke due to unusual causes, the pharmacological preventive treatment described above may need modification. For symptomatic carotid stenosis, carotid surgery is recommended, preferably within the first 14 days after onset. A surgical preventive treatment is closure of patent foramen ovale in patients aged 18-60 years with ischemic stroke of unknown cause.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2023
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-108107 (URN)37668114 (PubMedID)
Available from: 2023-09-06 Created: 2023-09-06 Last updated: 2024-01-02Bibliographically approved
Engdahl, J., Straat, K., Isaksson, E., Rooth, E., Svennberg, E., Norrving, B., . . . Wester, P. (2023). Multicentre, national, investigator-initiated, randomised, parallel-group, register-based superiority trial to compare extended ECG monitoring versus standard ECG monitoring in elderly patients with ischaemic stroke or transient ischaemic attack and the effect on stroke, death and intracerebral bleeding: the AF SPICE protocol. BMJ Open, 13(11), e073470
Open this publication in new window or tab >>Multicentre, national, investigator-initiated, randomised, parallel-group, register-based superiority trial to compare extended ECG monitoring versus standard ECG monitoring in elderly patients with ischaemic stroke or transient ischaemic attack and the effect on stroke, death and intracerebral bleeding: the AF SPICE protocol
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 11, p. e073470-Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and transient ischaemic attack (TIA), and AF detection can be challenged by asymptomatic and paroxysmal presentation. Long-term ECG monitoring after ischaemic stroke or TIA is recommended by all major societies in cardiology and cerebrovascular medicine as a secondary prophylactic measure. However, data on stroke reduction are lacking, and the recommendations show significant diversity.

METHODS AND ANALYSIS: AF SPICE is a multicentre, national, investigator-initiated, randomised, parallel-group, register-based trial comparing extended ECG monitoring versus standard ECG monitoring in patients admitted with ischaemic stroke or TIA, with a composite endpoint of stroke, all-cause-mortality and intracerebral bleeding. Patients aged ≥70 years without previous AF will be randomised 1:1 to control (standard ECG monitoring) or intervention (extended ECG monitoring). In the control arm, patients will undergo 48±24 hours (ie, a range of 24-72 hours) of continuous ECG monitoring according to national recommendations. In the intervention arm, patients will undergo 14+14 days of continuous ECG monitoring 3 months apart using an ECG patch device, which will provide an easy-accessed, well-tolerated 14-day continuous ECG recording. All ECG patch recordings will be read in a core facility. In cases of AF detection, oral anticoagulation will be recommended if not contraindicated. A pilot phase has been concluded in 2022, which will transcend into the main trial during 2023-2026, including approximately 30 stroke units. The sample size was calculated to be 3262 patients. The primary outcome will be collected from register data during a 36-month follow-up.

ETHICS AND DISSEMINATION: Ethical approval has been provided by the Swedish Ethical Review Authority, reference 2021-02770. The trial will be conducted according to the ethical principles of the Declaration of Helsinki and national regulatory standards. Positive results from the study have the potential for rapid dissemination in clinical practice.

TRIAL REGISTRATION NUMBER: NCT05134454.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Cardiology, Stroke, Thromboembolism
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-109870 (URN)10.1136/bmjopen-2023-073470 (DOI)37996238 (PubMedID)2-s2.0-85177747244 (Scopus ID)
Available from: 2023-11-24 Created: 2023-11-24 Last updated: 2024-02-05Bibliographically approved
Tofiq, a., Eriksson Crommert, M., Zakrisson, A.-B., von Euler, M. & Nilsing Strid, E. (2023). Physical functioning post-COVID-19 and the recovery process: a mixed methods study. Disability and Rehabilitation, 1-10
Open this publication in new window or tab >>Physical functioning post-COVID-19 and the recovery process: a mixed methods study
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2023 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To describe physical functioning after severe COVID-19-infection.

MATERIALS AND METHOD: An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation.

RESULTS: At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms.

CONCLUSION: Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
COVID-19, SARS-CoV-2, exercise, physical activity, qualitative research, recovery of function, rehabilitation, severe acute respiratory syndrome
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:oru:diva-105614 (URN)10.1080/09638288.2023.2201512 (DOI)000971399700001 ()37078388 (PubMedID)2-s2.0-85153473582 (Scopus ID)
Available from: 2023-04-21 Created: 2023-04-21 Last updated: 2024-01-15Bibliographically approved
Eriksson, M., Grundberg, A., Inge, E. & von Euler, M. (2023). Stroke Recurrence Following 28 Days After First Stroke in Men and Women 2012 to 2020: Observations From the Swedish Stroke Register. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 12(3), Article ID e028222.
Open this publication in new window or tab >>Stroke Recurrence Following 28 Days After First Stroke in Men and Women 2012 to 2020: Observations From the Swedish Stroke Register
2023 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 12, no 3, article id e028222Article in journal (Refereed) Published
Abstract [en]

Background: Stroke incidence, care, and survival show continuous improvements in Sweden, including no or decreasing disparities between men and women. In this study, we aimed to estimate and compare the risk of stroke recurrence in men and women over time, accounting for the competing risk of death.

Methods and Results: We included adult patients with first-time stroke (ischemic or intracerebral hemorrhage) registered in Riksstroke (the Swedish Stroke Register), 2012 to 2020, and followed until December 2020. Stroke recurrences included new events registered in Riksstroke from 28 days after stroke. To account for the competing risk of death, we used the cumulative incidence function to estimate crude incidences, and multivariable Cox regression to estimate cause-specific hazard ratios (HRs) adjusting for differences in patients' risk factor profiles. The study included 72 148 (53.5%) men and 62 689 (46.5%) women. We observed 10 925 stroke recurrences and 81 811 deaths following the initial 28 days after the first stroke. The cumulative incidence of stroke recurrence was 3.7% (95% CI, 3.6-3.8) after 1 year, 7.0 (95% CI, 6.8-7.1) after 3 years, and 9.1% (95% CI, 8.9-9.3) after 5 years. The incidence decreased substantially during the study period (HR, 2019-2020 versus 2012, 0.824 [95% CI, 0.759-0.894]). Overall, men had a lower risk of stroke recurrence. After adjustments for differences in patient characteristics, men had a slightly higher risk of recurrence (of any type) after an ischemic stroke (HR, 1.090 [95% CI, 1.045-1.138]) and a lower risk after hemorrhagic stroke (HR, 0.880 [95% CI, 0.781-0.991]) compared with women.

Conclusions: The risk of stroke recurrence has decreased in both men and women. Women's higher age and other differences in risk factors partly explain their higher risk of stroke recurrence compared with men.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Competing risk, sex differences, stroke, stroke recurrence
National Category
Neurology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-103395 (URN)10.1161/JAHA.122.028222 (DOI)000950277200018 ()36688356 (PubMedID)2-s2.0-85147536215 (Scopus ID)
Available from: 2023-01-24 Created: 2023-01-24 Last updated: 2023-04-12Bibliographically approved
Rejnö, Å., Bråndal, A., von Euler, M. & Pessah-Rasmussen, H. (2023). Strokerehabilitering ur ett vårdkedjeperspektiv: [Rehabilitation of stroke in a »chain of care« perspective]. Läkartidningen, 120(36-37), Article ID 23060.
Open this publication in new window or tab >>Strokerehabilitering ur ett vårdkedjeperspektiv: [Rehabilitation of stroke in a »chain of care« perspective]
2023 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, no 36-37, article id 23060Article in journal (Refereed) Published
Abstract [sv]

Strokerehabilitering har olika faser, då behovet varierar mellan individer och över tid. Olika kompetenser och metoder måste samordnas längs hela vårdkedjan.

Det finns stark evidens för teambaserad strokevård och rehabilitering i akut och subakut fas samt beprövad erfarenhet av teambaserad rehabilitering i senare skede.

Tidig understödd utskrivning från sjukhus med rehabilitering i hemmet (early supported discharge, ESD) rekommenderas för personer med lindrig till måttlig stroke.

Stroke är en kronisk sjukdom. Livslång strukturerad uppföljning med fokus på medicinsk behandling, livsstilsfaktorer, psykiskt och fysiskt mående, aktivitetsförmåga och delaktighet är nödvändig.

Abstract [en]

Rehabilitation is a key aspect of the treatment of stroke patients, both acute and in later phases. The patients' needs varies between individuals and over time. Several skills and methods and different professionals working together in teams, as well as coordination along the entire chain of care, are required in order to meet those different needs. Early supported discharge, ESD, is recommended for patients with mild to moderate stroke. Stroke is a chronic disease requiring lifelong structured follow-up focusing not only on medical treatment but also on lifestyle, mental and physical well-being and activity and participation.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2023
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-108104 (URN)37668116 (PubMedID)
Available from: 2023-09-06 Created: 2023-09-06 Last updated: 2024-01-02Bibliographically approved
Ullberg, T., von Euler, M., Wassélius, J., Wester, P. & Arnberg, F. (2023). Survival and functional outcome following endovascular thrombectomy for anterior circulation acute ischemic stroke caused by large vessel occlusion in Sweden 2017-2019-a nationwide, prospective, observational study. Interventional Neuroradiology, 29(1), 94-101
Open this publication in new window or tab >>Survival and functional outcome following endovascular thrombectomy for anterior circulation acute ischemic stroke caused by large vessel occlusion in Sweden 2017-2019-a nationwide, prospective, observational study
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2023 (English)In: Interventional Neuroradiology, ISSN 1591-0199, E-ISSN 2385-2011, Vol. 29, no 1, p. 94-101Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), but data on nationwide performance in routine healthcare are sparse. The study aims were to describe EVT patients with LVO AIS, analyze mortality and functional outcome, and compare results with randomized controlled trials (RCTs).

METHODS: Data from the Riksstroke and the Swedish Endovascular Treatment of Acute Stroke Registry (RSEVAS) on pre-stroke independent patients, with LVO AIS in 2017-2019, defined as occlusion of the intracranial internal carotid artery, or the M1 or M2 segments of the middle cerebral artery, and groin puncture <6 h of onset, were compared to aggregated HERMES collaboration RCT data. We assessed 90-day survival and function, defined by the modified Rankin Scale. Specific analyzes were stratified by occlusion location.

RESULTS: In all, 1011/2560 of RSEVAS patients matched RCT inclusion criteria. Compared with RCT data, patients were older (73 vs. 68), fewer received intravenous thrombolysis (63.1% vs. 83%), and M2 occlusions were more common (24.5% vs. 8%). 90-day survival in RSEVAS was 85.3%, 42.8% achieved good outcome and 5% had symptomatic intracerebral hemorrhage (sICH). Corresponding outcomes in RCT data were 84.7% survival, 46% good outcome, and 4.4% sICH. Functional outcome was most favorable following M2 occlusions.

CONCLUSIONS: EVT patients from our large real-world national dataset differed from RCT patients in several baseline factors including distribution of vascular occlusion site. However, the overall outcome of EVT in our Swedish cohort appeared to well match the pivotal trial findings.

Place, publisher, year, edition, pages
Edizioni del Centauro, 2023
Keywords
Reperfusion, acute stroke therapy, functional outcome, ischemic stroke, registry, survival
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-96584 (URN)10.1177/15910199211073019 (DOI)000748884800001 ()35044270 (PubMedID)2-s2.0-85147047447 (Scopus ID)
Note

Funding agency:

SUS Stiftelser och Fonder

Available from: 2022-01-20 Created: 2022-01-20 Last updated: 2024-01-02Bibliographically approved
Keselman, B., Berglund, A., Ahmed, N., Grannas, D., von Euler, M., Holmin, S., . . . Mazya, M. V. (2022). Analysis and modelling of mistriage in the Stockholm stroke triage system. European Stroke Journal, 7(2), 126-133
Open this publication in new window or tab >>Analysis and modelling of mistriage in the Stockholm stroke triage system
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2022 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 7, no 2, p. 126-133Article in journal (Refereed) Published
Abstract [en]

Introduction: The Stockholm Stroke Triage System (SSTS) is a prehospital triage system for detection of patients eligible for endovascular thrombectomy (EVT). Assessment of hemiparesis combined with ambulance-hospital teleconsultation is used to route patients directly to the thrombectomy centre. Some patients are not identified and require secondary transport for EVT (undertriage) while others taken to the thrombectomy centre do not undergo EVT (overtriage). The aims of this study were to characterize mistriaged patients, model for and evaluate alternative triage algorithms.

Patients and methods: Patients with suspected stroke transported by priority 1 ground ambulance between October 2017 and October 2018 (n = 2905) were included. Three triage algorithms were modelled using prehospital data. Decision curve analysis was performed to calculate net benefit (correctly routing patients for EVT without increasing mistriage) of alternative models vs SSTS.

Results: Undertriage for EVT occurred in n = 35/2582 (1.4%) and overtriage in n = 239/323 (74.0%). Compared to correct thrombectomy triages, undertriaged patients were younger and had lower median NIHSS (10 vs 18), despite 62.9% with an M1 occlusion. In overtriaged patients, 77.0% had a stroke diagnosis (29.7% haemorrhagic). Hemiparesis and FAST items face and speech were included in all models. Decision curve analysis showed highest net benefit for SSTS for EVT, but lower for large artery occlusion (LAO) stroke.

Discussion: Undertriaged patients had lower NIHSS, likely due to better compensated proximal occlusions. SSTS was superior to other models for identifying EVT candidates, but lacked information allowing comparison to other prehospital scales.

Conclusion: Using prehospital data, alternative models did not outperform the SSTS in finding EVT candidates.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
Stroke, ambulance, thrombectomy, triage, decision curve analysis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-98278 (URN)10.1177/23969873221077845 (DOI)000763503300001 ()35647317 (PubMedID)2-s2.0-85125492831 (Scopus ID)
Funder
Stockholm County CouncilSwedish Heart Lung Foundation
Note

Funding agencies:

Söderberg Foundations

MedTechLabs

Available from: 2022-03-28 Created: 2022-03-28 Last updated: 2024-01-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3845-8100

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