Recognition of Thrombectomy Candidate Clinical Trial
Official title:
Implementation of Finnish Prehospital Stroke Scale (FPSS) to Emergency Medical Services - a Prospective, Multi-centre Study
The investigators have developed a simple prehospital stroke scale (FPSS), containing 5 dichotomized items to recognize both large and small artery thrombi of the brain. FPSS is implemented to both emergency medical services and later, to emergency response centers. The efficacy of the scale and possible improvement of both the patient flow and treatment results will be evaluated.
Finnish Prehospital Stroke Scale, FPSS, was developed for prehospital setting for prediction
of large vessel occlusions (LVOs) and stroke in common. It contains four stroke signs used
universally in emergency medical services (EMSs) and emergency response centers (ERCs): 1)
facial weakness, 2) extremity weakness, 3) speech disturbance, 4) visual disturbance.
Additionally, it contains only one item 5) conjugated gaze deviation, while all the items are
presented in dichotomized form. In an earlier, retrospective cohort of 856 code stroke
patients, the sensitivity of FPSS for LVOs was highest for thrombi of areas with the
documented cost effectiveness of endovascular treatment: internal carotid artery (ICA) and M1
segment of middle cerebral artery (72 % and 82 %). The overall specificity of FPSS for the
LVOs was 91 %. For its simplicity it is easy to implement in EMS and ERC as a single score
predicting both thrombolysis and thrombectomy candidates.
In the present study accuracy of FPSS will be studied prospectively. FPSS is launched 5/18 in
EMS in an area with a population of more than a million, containing districts of five central
hospitals capable for thrombolysis and one university hospital capable for endovascular
treatment. During 2019-20 FPSS will be launched in two ERCs triaging stroke patients in the
study area.
The hypotheses that are tested are:
1. FPSS is accurate to detect ICA and M1 thrombi in EMS setting
2. The use of FPSS shortens door-in-door-out (DIDO) delay patients arriving to central
hospitals and redirected to university hospital for thrombectomy.
3. The use of FPSS aids to triage LVO-patients straight to a center capable for
thrombectomy
4. FPSS is accurate in the detection of ICA and M1 thrombi in ERC setting
5. The effect of fluent triage of LVO is seen in overall shortened recanalization delay and
better outcomes as lower modified Rankin Scores (mRS) in 3 months control compared
recanalization delays and 3 month mRS during the pre-implementation period.
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