The Stockholm Stroke Triage System (SSTS), implemented in 2017, identifies patients with high likelihood of large vessel occlusion (LVO) stroke. Using a 3-step algorithm including an ambulance-to-hospital teleconsultation, high likelihood patients bypass the primary stroke center. Previous reports have shown SSTS to notably reduce time to endovascular thrombectomy (EVT) and improve outcomes. As the indication for EVT now includes patients up to 24 hours, we aimed to assess SSTS triage accuracy for LVO stroke and EVT treatment for patients presenting late (within 6-24 hours or with an unknown onset), put in contrast to triage accuracy within 0-6 h.
Between October 2017 and October 2018, we included 2905 patients with suspected stroke, transported by priority 1 ground ambulance to a Stockholm Region hospital. Patients assessed 6-24 hours from last known well or with unknown onset were defined as late-presenting; those within 6 hours as early-presenting. Triage positivity was defined as transport to comprehensive stroke center due to suspected stroke, hemiparesis and high likelihood of EVT-eligible LVO per teleconsultation.
Overall triage accuracy was high in late-presenting patients (90.9% for LVO,93.9% for EVT), with high specificity (95.7% for LVO, 94.5% for EVT), and low to moderate sensitivity (34.3% for LVO, 64.7% for EVT), with similar findings in the early-presenting group.
Our results support using the SSTS for primary stroke center bypass in patients assessed by ambulance up to 24 hours from time of last known well.
Not applicable