https://scholars.lib.ntu.edu.tw/handle/123456789/612494
標題: | Prehospital-Stroke-Scale Parameterized Hospital Selection Protocol for Suspected Stroke Patients Considering Door-to-Treatment Durations | 作者: | Wang, Chun-Han Chang, Yu-Chen Yang, Yung WEN-CHU CHIANG SUNG-CHUN TANG LI-KAI TSAI CHUNG-WEI LEE JIANN-SHING JENG MATTHEW HUEI-MING MA MING-JU HSIEH Lee, Yu-Ching |
關鍵字: | emergency medical service; hospital selection protocol; large vessel occlusion; stroke | 公開日期: | 5-四月-2022 | 出版社: | WILEY | 卷: | 11 | 期: | 7 | 起(迄)頁: | e023760 | 來源出版物: | Journal of the American Heart Association | 摘要: | Background To mitigate uncertainty that may arise in the judgment of emergency medical technicians when relying on a prehospital stroke scale at the scene, we propose a hospital selection protocol that considers the uncertainty of a prehospital stroke scale and the actual door-to-treatment durations, and we have developed a web-based system to be used with mobile devices. Methods and Results This hospital selection protocol incorporates real-time, estimated transport time obtained from Google Maps, historical median door-to-treatment duration at hospitals that only provide the standard intravenous thrombolysis treatment, and at hospitals with endovascular thrombectomy for probable large-vessel occlusion cases. We have validated the efficiency of the proposed protocol and compared it with other strategies used by emergency medical technicians when deciding on a receiving hospital. Using the proposed protocol for the triage reduces the time from onset to receiving definitive treatment by nearly 11 minutes. We found that the nearest endovascular thrombectomy-capable hospital from the scene may not be the most ideal if the door-to-treatment durations are discriminative. The results show that, when the tolerable bypass transport threshold and administration time are reduced to 9 minutes and 30.5 minutes, respectively, 228 patients out of 7678 cases, whose receiving hospitals were changed to endovascular thrombectomy-capable hospitals, received definitive treatment in a shorter time. The results of our analysis give recommendations for appropriate allowable bypass transport time for regional planning. Conclusions By applying almost-real value parameters, we have validated a web-based model, which can be universally adapted for optimal, time-saving hospital selection for patients with stroke. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/612494 | ISSN: | 2047-9980 | DOI: | 10.1161/JAHA.121.023760 |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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