Prehospital neurological deterioration in stroke

Sabreena J. Slavin, Heidi Sucharew, Kathleen Alwell, Charles J. Moomaw, Daniel Woo, Opeolu Adeoye, Matthew L. Flaherty, Simona Ferioli, Jason McMullan, Jason Mackey, Felipe De Los Rios La Rosa, Sharyl Martini, Brett M. Kissela, Dawn O. Kleindorfer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and purpose: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). Methods: Among the Greater Cincinnati/Northern Kentucky region (population ∼1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival. Results: Of 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61-83) years; 56% women; 21% black) were analysed. PND occurred in 129 cases (12%), including 9% of IS, 24% of ICH and 16% of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND. Conclusion: Haemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.

Original languageEnglish (US)
JournalEmergency Medicine Journal
DOIs
StateAccepted/In press - Apr 27 2018

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Stroke
Emergency Medical Services
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Atrial Fibrillation
Seizures
Demography
Hemorrhage
Blood Pressure
Glucose
Serum
Population

Keywords

  • neurology
  • prehospital care
  • stroke

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Slavin, S. J., Sucharew, H., Alwell, K., Moomaw, C. J., Woo, D., Adeoye, O., ... Kleindorfer, D. O. (Accepted/In press). Prehospital neurological deterioration in stroke. Emergency Medicine Journal. https://doi.org/10.1136/emermed-2017-207265

Prehospital neurological deterioration in stroke. / Slavin, Sabreena J.; Sucharew, Heidi; Alwell, Kathleen; Moomaw, Charles J.; Woo, Daniel; Adeoye, Opeolu; Flaherty, Matthew L.; Ferioli, Simona; McMullan, Jason; Mackey, Jason; De Los Rios La Rosa, Felipe; Martini, Sharyl; Kissela, Brett M.; Kleindorfer, Dawn O.

In: Emergency Medicine Journal, 27.04.2018.

Research output: Contribution to journalArticle

Slavin, SJ, Sucharew, H, Alwell, K, Moomaw, CJ, Woo, D, Adeoye, O, Flaherty, ML, Ferioli, S, McMullan, J, Mackey, J, De Los Rios La Rosa, F, Martini, S, Kissela, BM & Kleindorfer, DO 2018, 'Prehospital neurological deterioration in stroke', Emergency Medicine Journal. https://doi.org/10.1136/emermed-2017-207265
Slavin SJ, Sucharew H, Alwell K, Moomaw CJ, Woo D, Adeoye O et al. Prehospital neurological deterioration in stroke. Emergency Medicine Journal. 2018 Apr 27. https://doi.org/10.1136/emermed-2017-207265
Slavin, Sabreena J. ; Sucharew, Heidi ; Alwell, Kathleen ; Moomaw, Charles J. ; Woo, Daniel ; Adeoye, Opeolu ; Flaherty, Matthew L. ; Ferioli, Simona ; McMullan, Jason ; Mackey, Jason ; De Los Rios La Rosa, Felipe ; Martini, Sharyl ; Kissela, Brett M. ; Kleindorfer, Dawn O. / Prehospital neurological deterioration in stroke. In: Emergency Medicine Journal. 2018.
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abstract = "Background and purpose: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). Methods: Among the Greater Cincinnati/Northern Kentucky region (population ∼1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival. Results: Of 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61-83) years; 56{\%} women; 21{\%} black) were analysed. PND occurred in 129 cases (12{\%}), including 9{\%} of IS, 24{\%} of ICH and 16{\%} of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND. Conclusion: Haemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.",
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AU - Sucharew, Heidi

AU - Alwell, Kathleen

AU - Moomaw, Charles J.

AU - Woo, Daniel

AU - Adeoye, Opeolu

AU - Flaherty, Matthew L.

AU - Ferioli, Simona

AU - McMullan, Jason

AU - Mackey, Jason

AU - De Los Rios La Rosa, Felipe

AU - Martini, Sharyl

AU - Kissela, Brett M.

AU - Kleindorfer, Dawn O.

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N2 - Background and purpose: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). Methods: Among the Greater Cincinnati/Northern Kentucky region (population ∼1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival. Results: Of 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61-83) years; 56% women; 21% black) were analysed. PND occurred in 129 cases (12%), including 9% of IS, 24% of ICH and 16% of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND. Conclusion: Haemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.

AB - Background and purpose: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). Methods: Among the Greater Cincinnati/Northern Kentucky region (population ∼1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival. Results: Of 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61-83) years; 56% women; 21% black) were analysed. PND occurred in 129 cases (12%), including 9% of IS, 24% of ICH and 16% of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND. Conclusion: Haemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.

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