Abstract 252: Implementation and Ongoing Evaluation of a Novel Method for Stroke Severity Assessment and Routing: NYC S-LAMS

Introduction: For the New York City 911 system stroke population, we sought to create and monitor a system for identifying stroke and large vessel occlusion (LVO) and to route LVO patients to thrombectomy capable centers which would reduce delays in the provision of endovascular care.

Methods: We trained all emergency medical technicians and paramedics in the NYC 911 system to perform the Los Angeles Motor Score and to evaluate speech in cases of suspected stroke. We used a minimum score of 4/6 on a combined scale to screen positive for a possible LVO. An on-line medical control (OLMC) contact was required for every case that screened positive. Patients were eligible for transport specifically to thrombectomy capable centers if they screened positive, symptoms were present for less than 5 hours, symptoms were not due to trauma or seizure and the patient was previously ambulatory.

Results: In the first six months of activity, there were 907 OLMC contacts, consistent with our prediction of approximately 5 patients per day that was derived from our 911 system’s historical database. After excluding ineligible patients, of these, 328 were transported to primary stroke centers and 579 were transported to thrombectomy capable centers. Of the 579 transported to thrombectomy capable centers, 447 (77.2%) had a confirmed stroke diagnosis. There were 189 (32.6%) LVO cases and 76 (13.1%) intracranial hemorrhages. Median time from EMS arrival to endovascular intervention first pass was 182.6 minutes and from hospital arrival to first pass was 141.5 minutes.

Discussion: Overall, the process behaved as expected. We believe that our system can be further refined to reduce time to intervention. Further investigation is required to determine whether or not the system improved outcomes for patients and whether or not any cases of LVO or ICH were missed.