Abstract
Introduction: Acute ischemic stroke (AIS) caused by large vessel occlusions (LVOs) has high morbidity and mortality. Reliable prehospital identification of LVOs may improve patient care, hospital routing and ultimately outcomes. This analysis characterizes current expert opinion on preferred stroke scales for field assessment of LVOs, factors driving scale preferences and associated research data gaps in a sample of multidisciplinary key stakeholders who care for patients with AIS. Methods: In total, 248 HCPs from 4 specific disciplines responsible for AIS patient care were asked to participate in an in-person survey. The survey was administered by trained interviewers using structured interviews between Sep 2017 and Jan 2018. Responses were analyzed overall and stratified by HCP type with descriptive statistics. Results: Of 169 participating HCPs, 22% were general neurologists, 25% neuro-interventionalists, 24% emergency department physicians (38% emergency medical system [EMS] directors), 26% stroke coordinators and 2% other. Most respondents were from comprehensive stroke centers (64%) and represented a broad US geography. Among the respondents, 86% agreed or strongly agreed that prehospital stroke scales are effective in identifying LVOs, and 63% (n=107) had a preferred prehospital LVO scale ( Table ). Among those who stated a preference (n=107), 65% cited practical considerations for their choice (eg, ease of use, already in use by local EMS) and 46% cited the scale’s properties (psychometric or clinical). Regarding the greatest need in the prehospital assessment of stroke (n=169), 56% of respondents called for more research on LVO scales, 24% for other prehospital assessment tools and 26% for EMS training and standardization. Conclusions: The majority of HCPs surveyed support the use of prehospital LVO scales but request further research. No one scale was preferred over another.
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