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February 25, 2020; 94 (8) Editorial

Short cuts make long delays

Getting it right from the start in prehospital stroke triage

Lee H. Schwamm, View ORCID ProfileGeorge Ntaios
First published January 24, 2020, DOI: https://doi.org/10.1212/WNL.0000000000008994
Lee H. Schwamm
From the Comprehensive Stroke Center (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; and Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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George Ntaios
From the Comprehensive Stroke Center (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; and Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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Short cuts make long delays
Getting it right from the start in prehospital stroke triage
Lee H. Schwamm, George Ntaios
Neurology Feb 2020, 94 (8) 341-342; DOI: 10.1212/WNL.0000000000008994

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The approval in 1996 of alteplase for the treatment of acute ischemic stroke (AIS) prompted recognition of the need to organize and implement coordinated stroke systems of care to ensure optimal access to thrombolysis.1,2 For more than a decade, alteplase remained the sole agent proven effective in acute stroke reperfusion, and thus, the emergency medical services (EMS) system required a straightforward, one-size-fits-all approach of transporting all patients with early-onset suspected stroke to the nearest appropriate thrombolysis-capable center. However, after proven benefit of thrombectomy for stroke due to large vessel occlusion (LVO), evaluation of people with severe stroke and treatment with endovascular thrombectomy (EVT) have become Class 1, Level A recommendations. Recently published data of efficacy up to 24 hours and evidence of harm from interfacility transfer-related delays3 increased exponentially the complexity of prehospital triage for suspected AIS. With many imperfect prehospital stroke screens and severity scales to choose from, the question becomes, not if, but how should we prioritize triage of suspected LVO stroke?

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  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.

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  • © 2020 American Academy of Neurology
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