Abstract WMP64: Prehospital Triage To Comprehensive Stroke Centers: GCS Identifies Patients At Increased Risk For Death, ICH, Or SAH

Abstract

INTRODUCTION: Regionalization of stroke care is occurring nationwide, but evidence-based criteria for prehospital triage to comprehensive stroke centers are lacking. We assessed the hypothesis that a prehospital clinical decision rule can identify a group of patients more likely to require comprehensive stroke services--those with an increased risk of in-hospital mortality, ICH, or SAH. METHODS: This study represents a retrospective cohort of patients seen by an urban EMS system from 2000-2003. Subjects were included if they had either a prehospital diagnosis of “stroke/TIA” or a prehospital diagnosis of “decreased level of consciousness” or “headache” and signs and symptoms suggestive of a cerebrovascular event. The primary outcome was a composite of in-hospital mortality, ICH, or SAH. Multivariate logistic regression was used to derive a clinical prediction rule. RESULTS: In 1682 subjects, the discharge diagnoses included TIA (n = 282, 17%), ischemic stroke (n = 433, 26%), ICH (n = 102, 6%), and SAH (n = 30, 2%). There were 221 patients (13%) who experienced the primary outcome: 67 (4%) with non-fatal ICH or SAH and 154 (9%) who died. Using GCS score alone, the area under ROC curve was 0.72, and GCS ≤ 10 resulted in a sensitivity of 0.48 (95%CI 0.42, 0.55) and specificity of 0.88 (95%CI 0.87, 0.90). A six-point prehospital stroke triage score (PSTS) was also derived: nausea/vomiting (1 point), systolic BP ≥ 175 (1 point), GCS 7-10 (2 points) and GCS 3-6 (4 points). The area under ROC curve for the PSTS was 0.74. Test characteristics for PSTS and GCS were similar (Table). CONCLUSION: GCS alone performed similarly to a six-point clinical decision rule for the prehospital identification of patients at increased risk of death, ICH or SAH. GCS has potential utility as a criterion for the prehospital triage to comprehensive stroke centers.