Abstract T MP50: Appropriate Stroke Team Activations Through Use of Los Angeles Pre-hospital Stroke Scale (LAPSS)

Background and Purpose: Target Stroke SM aims to reduce the Door to Needle (DTN) times to 60 minutes or less in eligible ischemic stroke patients. They advocate Emergency Medical Service (EMS) pre-notification, a rapid triage protocol,stroke team notification, and a single call activation system 1 . Prior to February 2013 the Stroke Team averaged 92.8 Stroke Team Activations monthly. This volume placed a burden on the Stroke Team and ancillary departments. DeLuca and colleagues noted a possible criticism of Stroke Code in that patients with symptoms mimicking a stroke may overload the stroke personnel 2. We set out to decrease unnecessary stroke team activations without missing an opportunity to treat an eligible patient. Methods: A retrospective chart review was performed on all Stroke Team Activations between February and July 2012. We identified the volume of cancelled activations, number of patients too late or symptoms too mild, stroke mimics and treatments provided. The Los Angeles Pre-hospital Stroke Scale (LAPSS) was chosen as a screening tool for Medical Command to use with EMS personnel. The Stroke Team Activation time was shortened from 8 to 6 hours from last known well. The Emergency Department physicians had override authority for Activations. The revised Stroke Team Activation Guideline was disseminated in early 2013. To assess the utility of LAPSS as a Stroke Team Activation tool we compared the pre-LAPSS to the post-LAPSS data. A report completed by Medical Command on all requested Stroke Team Activations was also reviewed. Outcomes: A total of 557 patients were reviewed pre-LAPSS and 426 post-LAPSS. In comparison, the updated Stroke Team Activation Guideline resulted in a decrease of stroke team activations by 23.5%. Average DTN times remained under 60 minutes. A higher percent of patients seen were treated with rtPA (8.6% pre vs. 9.9% post). We have not missed the opportunity to treat an eligible stroke patient. Conclusion: A higher percentage of patients can be treated with DTN times under 60 minutes without overburdening the Stroke Team when procedures are in place for optimum specificity to identify those patients who would benefit from rapid team activation and stroke intervention.