Abstract
453: A NOVEL ALGORITHM FOR PREHOSPITAL STROKE TRIAGE: A POPULATION-BASED IN SILICO TRIAL
Critical care medicine, Vol.54(3S), 453
03/2026
DOI: 10.1097/01.ccm.0001183808.37603.47
Abstract
Introduction: Effective prehospital stroke triage is essential for optimizing access to time-sensitive therapies. The objective of this study was to evaluate the clinical impact of a novel personalized prehospital stroke triage algorithm based on Bayesian predictive modeling to improve stroke outcomes.
Methods: To develop the Modeling Ambulance-based Prehospital Stroke Triage to Optimize Recovery (MAP-STROKE) destination selection algorithm, we used clinical trials data to model time-varying treatment efficacy of thrombolytic treatment and thrombectomy. Then we derived a diagnostic model (outcome=stroke subtype) and a treatment model (outcome=modified Rankin Scale [mRS]) to predict 3-month neurologic outcome for an individual patient. To estimate the impact of triage scenarios, we simulated stroke events in the U.S. over a 10-year period, then we predicted neurologic outcomes for this population under different scenarios: MAP-STROKE triage, AHA guideline, and nearest hospital routing.
Results: In our simulated population of 145 million stroke alerts across 20 replications, MAP-STROKE recommended the same hospital as the AHA guidelines in 39.6% of cases. Including all patients with a prehospital stroke alert, the MAP-STROKE algorithm improved the number of patients with good neurologic outcome by 0.5% (95% credible interval [Cr-I] 0.4-0.5%) over AHA guidelines and 0.7% (95%Cr-I 0.7-0.8%) over nearest hospital routing. In the subgroup of patients with large vessel occlusion (LVO), though, the neurologic improvement over AHA guidelines was greater (4.8% increase, 95% Cr-I 4.7-4.8%), which was even more pronounced for rural LVO patients (8.3% increase, 95%Cr-I 8.0-8.5%). Much of this change was attributable to a 76.5 min (95%Cr-I 76.0-77.0) reduction in time to thrombectomy compared with AHA guideline-adherent routing. These benefits were tempered by a 0.3% decrease in good neurologic outcome in non-LVO ischemic stroke patients, attributable to a 20.9 min delay in thrombolytic use and 2.7% fewer non-LVO patients who received thrombolytic treatment.
Conclusions: In prehospital stroke alert patients, use of the MAP-STROKE algorithm was estimated to improve good neurologic recovery through improved triage and destination selection. This improvement was most pronounced for LVO patients and those in rural areas.
Details
- Title: Subtitle
- 453: A NOVEL ALGORITHM FOR PREHOSPITAL STROKE TRIAGE: A POPULATION-BASED IN SILICO TRIAL
- Creators
- Nicholas Mohr - University of IowaGrant Brown - University of IowaJacob Seedorf - University of IowaFerney Henao-Ceballos - University of IowaAnne Zepeski - University of IowaJorge Cespedes Segura - University of IowaEric Kontowicz - University of IowaDan Shane - University of IowaNatalia Perez de la Ossa - N/AMarc Ribo - N/AJeffrey Saver - University of California, Los AngelesSantiago Ortega-Gutierrez - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Critical care medicine, Vol.54(3S), 453
- DOI
- 10.1097/01.ccm.0001183808.37603.47
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Publisher
- Lippincott Williams & Wilkins
- Language
- English
- Date published
- 03/2026
- Academic Unit
- Neurology; Radiology; Health Management and Policy; Epidemiology; Economics; Emergency Medicine; Iowa Neuroscience Institute; Biostatistics; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9985144718602771
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