European Stroke Initiative Recommendations for Stroke Management

2000 ◽  
Vol 10 (5) ◽  
pp. 335-351 ◽  
Keyword(s):  
Stroke Management ◽  
European Stroke Initiative

scholarly journals Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Stefanie Behnke ◽  
Thomas Schlechtriemen ◽  
Andreas Binder ◽  
Monika Bachhuber ◽  
Mark Becker ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Unsolved Problem ◽  
Standard Operating Procedure ◽  
Stroke Management ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Standard Operating ◽  
Los Angeles Motor Scale ◽  
Triage Decisions

Abstract Background The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. Methods Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. Results In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0–79.5%) and a specificity of 84.9% (95%-CI: 82.6–87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4–26.5%); specificity, 100% (95%-CI: 100–100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1–78.0%) and a specificity of 83.5% (95%-CI: 81.0–86.0%). Conclusions State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.

scholarly journals Prehospital scales in acute ischaemic stroke management

2021 ◽  
Vol 20 (7) ◽  
pp. 504
Author(s):  
Fabio Bandini ◽  
Lucilla Vestito ◽  
Laura Filippi
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Management

scholarly journals 306 The Changing Face of Stroke in the DOAC Era

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Recie Davern ◽  
Helena Hobbs ◽  
Hannah Murugan ◽  
Paul Cotter
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
P Value ◽  
Stroke Management ◽  
Medicines Management ◽  
First Line ◽  
Stroke Registry ◽  
Multiple Factors ◽  
Direct Acting ◽  
Anticoagulated Patients

Abstract Background Patients prescribed oral anticoagulants (OAC) for atrial fibrillation (AF) can still present with stroke. The mechanism for stroke in these patients can be due to multiple factors including subtherapeutic dosing and non-compliance. With the increasing use of direct-acting OACs (DOACs) in favour of warfarin, it is unclear if the incidence of stroke in those already taking OAC has reduced. Methods Data was extracted from our unit’s stroke registry, a prospectively maintained database, for patients who presented with stroke while receiving OAC for AF from 2013 to 2017. Type of OAC, type of stroke, OAC dosing at time of event including non-compliance, stroke management and outcome were recorded. Results 67 patients were included for analysis, with 55 ischaemic and 12 haemorrhagic strokes. 52 patients were receiving warfarin at the time of their stroke vs. 15 receiving DOACs. 33/55 (60%) of ischaemic strokes occurred in patients taking warfarin with a sub-therapeutic INR. In 3/55 (5%) of ischaemic strokes, the OAC was held for a procedure while in 6/55 cases (11%) the OAC had been stopped for another reasons e.g. bleeding. 5/55 (7%) were due to non-compliance. 1 ischaemic stroke was due to under-dosing of a DOAC (dabigatran). 16 strokes were recorded in 2013 for patients prescribed OAC vs. 3 in 2017. Overall the number of ischaemic strokes due to subtherapeutic OAC decreased from 14 in 2013 to 1 in 2017 (p value 0.06). Conclusion The majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.

Aspects of stroke management including subarachnoid haemorrhage

2001 ◽  
Vol 14 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Robert J. van Oostenbrugge ◽  
Jaap Troost
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Stroke Management

Improving the outcome of acute stroke management

1999 ◽  
Vol 60 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Michael Hennerici
Keyword(s):  
Acute Stroke ◽  
Stroke Management

Exertional Heat Stroke Management Strategies in United States High School Football

2013 ◽  
Vol 42 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Zachary Y. Kerr ◽  
Stephen W. Marshall ◽  
R. Dawn Comstock ◽  
Douglas J. Casa
Keyword(s):  
United States ◽  
High School ◽  
Heat Stroke ◽  
Management Strategies ◽  
Stroke Management ◽  
High School Football ◽  
Exertional Heat Stroke

scholarly journals Prehospital scales in acute ischaemic stroke management – Authors' reply

2021 ◽  
Vol 20 (7) ◽  
pp. 504-505
Author(s):  
Martijne H C Duvekot ◽  
Esmee Venema ◽  
Henk Kerkhoff ◽  
Diederik W J Dippel ◽  
Bob Roozenbeek
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Management

Empfehlungen der European Stroke Initiative (EUSI) zur Behandlung des isch�mischen Schlaganfalls ? Aktualisierung 2003

2004 ◽  
Vol 75 (4) ◽  
pp. 368-379 ◽  
Author(s):  
Werner Hacke ◽  
Sonja K�lkens ◽  
Peter Arthur Ringleb
Keyword(s):  
European Stroke Initiative

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

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