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Prehospital selection of thrombectomy candidates beyond large vessel occlusion: M-DIRECT scale.
Rodríguez-Pardo, Jorge; Riera-López, Nicolas; Fuentes, Blanca; Alonso de Leciñana, María; Secades-García, Sergio; Álvarez-Fraga, Julia; Busca-Ostolaza, Pablo; Carneado-Ruiz, Joaquín; Díaz-Guzmán, Jaime; Egido-Herrero, José; Gil-Núñez, Antonio; Masjuan-Vallejo, Jaime; Real-Martínez, Verónica; Vivancos-Mora, José; Díez-Tejedor, Exuperio.
Afiliación
  • Rodríguez-Pardo J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Riera-López N; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Fuentes B; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Alonso de Leciñana M; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Secades-García S; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Álvarez-Fraga J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Busca-Ostolaza P; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Carneado-Ruiz J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Díaz-Guzmán J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Egido-Herrero J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Gil-Núñez A; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Masjuan-Vallejo J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Real-Martínez V; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Vivancos-Mora J; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
  • Díez-Tejedor E; From the Department of Neurology (J.R.-P., B.F., M.A.d.L., S.S.-G., J.Á-F., E.D.-T.), Hospital Universitario La Paz, Universidad Autónoma de Madrid; Department of Neurology (J.V.-M.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid; Stroke Code Coordination Center (N.R.-L., P.B.O.
Neurology ; 94(8): e851-e860, 2020 02 25.
Article en En | MEDLINE | ID: mdl-31980580
OBJECTIVE: Current prehospital scales used to detect large vessel occlusion reveal very low endovascular thrombectomy (EVT) rates among selected patients. We developed a novel prehospital scale, the Madrid-Direct Referral to Endovascular Center (M-DIRECT), to identify EVT candidates for direct transfer to EVT-capable centers (EVT-Cs). The scale evaluated clinical examination, systolic blood pressure, and age. Since March 2017, patients closer to a stroke unit without EVT capabilities and an M-DIRECT positive score have been transferred to the nearest EVT-C. To test the performance of the scale-based routing protocol, we compared its outcomes with those of a simultaneous cohort of patients directly transferred to an EVT-C. METHODS: In this prospective observational study of consecutive patients with stroke code seen by emergency medical services, we compared diagnoses, treatments, and outcomes of patients who were closer to an EVT-C (mothership cohort) with those transferred according to the M-DIRECT score (M-DIRECT cohort). RESULTS: The M-DIRECT cohort included 327 patients and the mothership cohort 214 patients. In the M-DIRECT cohort, 227 patients were negative and 100 were positive. Twenty-four (10.6%) patients required secondary transfer, leaving 124 (38%) patients from the M-DIRECT cohort admitted to an EVT-C. EVT rates were similar for patients with ischemic stroke in both cohorts (30.9% vs 31.5%). The M-DIRECT scale had 79% sensitivity, 82% specificity, and 53% positive predictive value for EVT. Recanalization and independence rates at 3 months did not differ between the cohorts. CONCLUSIONS: The M-DIRECT scale was highly accurate for EVT, with treatment rates and outcomes similar to those of a mothership paradigm, thereby avoiding EVT-C overload with a low rate of secondary transfers.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Transferencia de Pacientes / Trombectomía / Accidente Cerebrovascular / Servicios Médicos de Urgencia Tipo de estudio: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Neurology Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Transferencia de Pacientes / Trombectomía / Accidente Cerebrovascular / Servicios Médicos de Urgencia Tipo de estudio: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Neurology Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos