Performance of the Lausanne Ischemic Stroke Pathway prehospital triage system in identifying acute reperfusion candidates: a quality-control study.

Of 1071 included patients, the EMS phone-contacted the coordinated medical team (CMT) for 937 (87.5%).

• Retrospective single-centre quality-control study at a Swiss university-based stroke centre, 1 January 2019 to 31 May 2022.
• Inclusion: patients aged ≥18 years for whom the EMS called the CMT, or patients with AIS eligible for acute reperfusion managed by the EMS.

440 of 1071 patients (41%) had an acute ischaemic stroke eligible for acute reperfusion.

• The remaining patients did not have an AIS eligible for reperfusion and constituted the overtriaged group or other categories.

The overall system undertriage rate was 30%.

• 133 patients with an AIS eligible for acute reperfusion did not have the stroke pathway activated, among the 440 eligible patients.

Undertriage was 21% at the EMS step and 11% at the CMT step.

• The CMT's lower undertriage rate indicates that the second expert assessment reduced missed reperfusion candidates relative to EMS alone.

Overtriage was 63% for the EMS and 57% for the CMT.

• Overtriage was therefore also reduced, though modestly, by the CMT call.
• Overtriage and undertriage were both described by the authors as relatively high.

The main alternative diagnoses among overtriaged patients were seizures (14%), intracranial haemorrhages (9.9%) and functional disorders (6.5%).

• Identification of alternative diagnoses was a secondary outcome.
• The authors suggest better prehospital identification of alternative diagnoses such as seizures or functional disorders could help to better classify patients.

The authors conclude that the second expert assessment step by the CMT adds value to prehospital triage.

• Both undertriage and overtriage were reduced by the CMT call, which involves a higher level of expertise (neurologist plus emergency physician).