Browsing by Subject "Prehospital care"

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    Prehospital neurological deterioration in stroke
    (BMJ Publishing Group, 2018-08) Slavin, Sabreena J.; Sucharew, Heidi; Alwell, Kathleen; Moomaw, Charles J.; Woo, Daniel; Adeoye, Opeolu; Flaherty, Matthew L.; Ferioli, Simona; McMullan, Jason; Mackey, Jason; De Los Rios La Rosa, Felipe; Martini, Sharyl; Kissela, Brett M.; Kleindorfer, Dawn O.; Neurology, School of Medicine
    BACKGROUND AND PURPOSE: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). METHODS: Among the Greater Cincinnati/Northern Kentucky region (population ~1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival. RESULTS: Of 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61-83) years; 56% women; 21% black) were analysed. PND occurred in 129 cases (12%), including 9% of IS, 24% of ICH and 16% of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND. CONCLUSION: Haemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.
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    Use of Ultrasound in the Prehospital Setting: A Scoping Review
    (Elsevier, 2025-03-01) Warren, Jonathan; Tamhankar, Omkar; Toy, Jake; Schlesinger, Shira A.; Liu, Yiju Teresa; Medicine, School of Medicine
    Objectives: With the advent of portable devices, prehospital ultrasound is increasingly available and has the potential to provide clinical and procedural decision support. This scoping review seeks to examine current literature on prehospital ultrasound, including study indications, the level of the health care professionals performing prehospital ultrasound, and reported research outcomes. Methods: We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane databases for research articles and conference abstracts focused on prehospital ultrasound with scans performed in the field. After title/abstract screening by 2 independent reviewers, a full-text review was performed. We excluded reviews, case reports, letters to the editor, and research published in nonEnglish language. Descriptive statistics were reported. Results: We identified 9718 unique articles, and 109 were included after title/abstract review (Kappa 0.68) and full-text analysis. Annual publications increased yearly (P < .01). Nineteen countries were represented, with the United States having the highest number of publications (n = 34, 31.2%). Most studies were prospective (n = 74, 67.9%) with few randomized control trials (n = 6, 5.5%). Feasibility studies comprised 45.9% (n = 50) of the included publications, while clinical outcomes were the primary interest in 18 studies (16.5%). Physicians (n = 58, 53.2%) and paramedics (n = 38, 34.9%) were the most studied prehospital clinicians. The most common indication was trauma (n = 49, 45%) followed by dyspnea (n = 13, 11.9%) and cardiac emergencies (n = 10, 9.2%). Conclusion: There is a growing, heterogeneous body of literature describing the use of prehospital ultrasound. Published literature was primarily prospective and described feasibility trials. Identified gaps include a lack of studies in pediatric patients and research identifying clinical outcomes.