Emergency Medical Services
Abstracts
Background: With mechanical thrombectomy for large vessel strokes (LVOs) becoming more widespread, there is increased onus on prehospital personnel to identify LVOs, as this could influence their decision to preferentially transport LVO strokes to a comprehensive stroke center, where the mechanical thrombectomy procedure can be performed. As the 4th largest in the state, our county EMS system has over 800 pre-hospital providers and takes over 116,000 calls. For stroke calls, we use the Los Angeles Motor Scale (LAMS) as our evaluation tool. The LAMS is a validated 3-item prehospital scoring tool derived from the motor exam components of the Los Angeles Prehospital Stroke Screen (LAPSS), and identifies 3 areas of potential deficit: facial droop (absent/present), arm drift (absent/drifts down/falls rapidly), and grip strength (normal/weak grip/no grip). The objective of this study was to determine whether the initial prehospital LAMS correlates to hospital outcomes in patients with acute ischemic stroke (AIS).
Methods: This IRB approved prospective cohort study encompassed all patients who were transported for stroke by our county EMS agency to one of eight receiving hospitals. As part of our robust research and quality database, we have agreements with our receiving hospitals to provide hospital discharge outcomes on all patients transported to a given facility for stroke, including the National Institutes of Health Stroke Scale (NIHSS) at hospital arrival and discharge, and number of hospital days.
Results: Initial LAMS (n=311) ranged from 0 to 5 as follows: LAMS 0-12%; LAMS 1-10%, LAMS 2- 14%; LAMS 3-19%; LAMS 4-17%; LAMS 5-28%. The median NIHSS at hospital arrival was 8, with an IQR or 3 to 16. Median NIHSS at hospital discharge was 4, IQR 1 to 9.5. In terms of disposition, 5% died in the hospital, 39% were discharged home, 7% went to hospice, 23% went to a rehab facility, 21% went to a skilled nursing facility, and 3% were transferred to another hospital. Median number of hospital days was 4, IQR 3-7 days.
Patients with a higher LAMS score in the field were significantly more likely to have a higher NIHSS at hospital arrival (P2= 35%), a higher NIHSS at hospital discharge (P2= 10%) and have a longer hospital length of stay (P2= 5%.