CJEM Articles: Sandra E. Black
Displaying 1-2 of 2 results
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March
2010
12
2
Aikta Verma, David J. Gladstone, Jiming Fang, Jordan Chenkin, Richard Verbeek, Sandra E. Black
Objective: Prehospital Code Stroke triage has the potential to overwhelm stroke centres by falsely identifying patients as eli gible for fibrinolysis. We sought to determine whether online medical control (whereby paramedics contact the medical control physician before a Code Stroke triage is assigned) reduced the proportion of false-positive Code Stroke patients.
Methods: Following the introduction of a protocol for prehospi tal Code Stroke triage in an urban centre, online medical control alternated with off-line medical control (whereby paramedics implement Code Stroke triage independently) over 4 discreet intervals. We reviewed data for patients triaged to 3 regional stroke centres to compare the proportion of false-positive Code Stroke patients during online versus off-line medical control. We predefined false positives as patients triaged as Code Stroke who had symptoms discovered on awakening, were last seen in their usual state of health greater than 2 hours before assess ment or had a final diagnosis other than stroke.
Results: The proportion of false positives was lower during online medical control (31% v. 42%, p = 0.003). This was explained by a lower proportion of patients whose symptoms were discovered on awakening (8% v. 14%, p < 0.001) and who were last seen in their usual state of health greater than 2 hours before assessment (22% v. 32%, p = 0.005). A final diagnosis of stroke was similar in the 2 groups (77% v. 79%, p = 0.39), as was the proportion of patients receiving fibrinol ysis (35% v. 33%, p = 0.72). Eighteen percent of patients were denied Code Stroke triage during online control, most com monly because of the time of symptom onset.
Conclusion: Online medical control is associated with a reduced proportion of false-positive Code Stroke triage.
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January
2006
8
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Allan J. Fox, Babak Jahromi, David J. Gladstone, Devra Baryshnik, Richard I. Aviv, Rochelle Caratao, Sandra E. Black
Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (IV) and intra-arterial (IA) tPA. This case illustrates the potential value of the combined IV-IA thrombolytic approach, which is an emerging investigational treatment strategy for selected patients with severe acute ischemic stroke.
