Emergency medical services (EMS) leaders should coordinate with medical experts and local, regional, and state agencies to create triage paradigms and protocols to facilitate the rapid identification and assessment of patients with stroke or suspected stroke. This should involve the use of validated stroke screening tools such as the Face Arm Speech Test (FAST), the Cincinnati Prehospital Stroke Scale, or the Los Angeles Prehospital Stroke Screen.
In a revision from the 2013 guidelines, the new version recommends the establishment of a door-to-needle (DTN) time goal of ≤60 minutes in ≥50% of AIS patients treated with IV alteplase. “What is new is discussion about DTN times of 45 minutes or less in 50%of patients with acute ischemic stroke” as a secondary goal, Dr Favate noted. “This is most significant as it helps to maximize the critical timeline in stroke triage and initiation of treatment with tPA [tissue plasminogen activator].”
A few of the new or revised items in a section on telemedicine include the use of teleradiology and telestroke services for the expedited review of neuroimaging at sites without such capabilities in house; telestroke guidance for tPA administration; and telestroke decision support pertaining to the potential transfer of patients for thrombectomy.
It is now recommended that hospitals participate in a stroke data repository to promote adherence to current guidelines, improve patient outcomes, and facilitate quality improvement.
Hospitals should establish systems to allow the performance of brain imaging studies within 20 minutes of arrival to the ED in ≥50% of patients for whom IV alteplase and/or thrombectomy may be indicated.
Providers should not use the CT hyperdense middle cerebral artery sign as a criterion to withhold tPA from patients who would be candidates otherwise.