부산대학교 도서관

Introduction/PurposeThe outcomes of intra-arterial (IA) endovascular treatment in patients with large vessel occlusion (LVO) are time dependent. In order to identify emergency large vessel occlusion (ELVO) and notify the receiving hospital from the field, emergency medical services (EMS) in Ventura county of California use Ventura ELVO Scale (VES). Early notification of ELVO from the field can potentially shorten the door to needle and door to groin time by activation of Interventional Radiology (IR) team earlier and in future, it may help triage patients with stroke to comprehensive stroke center.Methods and AnalysisVentura ELVO Scale (VES) comprise of four components: 1) Eye Deviation 2) Aphasia 3) Neglect 4) Obtundation, each component scoring either 1 or 0. The maximum score is 4 and minimum score is 0. The score of 1 or greater will be considered as ELVO positive. VES was implemented by EMS to identify ELVO patients in the catchment area of Los Robles Hospital and Medical Center (LRHMC). A positive ELVO score along with positive Cincinnati scale prompts ELVO activation. EMS then calls the neuro-interventionalist who activates the neuro-intervention protocol at LRHMC. Retrospective de-identified data was collected from EMS run sheets, emergency department (ED) and IR records of LRHMC for cases in which the stroke code was activated by EMS during the period of Jan 2016 to Jan 2017.Abstract O-028 Table 1 Analysis of stroke codes activated by Ventura County EMS between Jan 2016 – Jan 2017Total Stroke Codes (n)204Total stroke codes with ELVO Positive– Male: Female – Mean age of patients (standard deviation) – Mean ELVO score (standard deviation)2611:15 77 (±13.01) 2.12(±1.13)Total ELVO positive stroke codes with confirmed LVO on angiogram– Mean door to IV t-pa time (standard deviation) – Mean door to groin time (standard deviation) – Mean door to reperfusion time (standard deviation)1823.20 mins. (±9.73) 73.20 mins. (±20.30)135.20 mins. (±32.77)Total ELVO positive stroke codes with no LVO on angiogram8Total stroke code with ELVO negative178Total stroke code with ELVO negative but LVO on angiogram1Sensitivity of VES94.74% Specificity of VES95.67% Positive predictive value of VES69.23%Negative Predictive value of VES99.44% ResultA total of 204 patients were activated as stroke code by Ventura county EMS, out of which 26 were activated as ELVO positive. The mean age of ELVO positive patients was 77 (SD ±13.01) with 11:15 male to female ratio. Large vessel occlusion (LVO) was confirmed in 18 out of 26 ELVO positive patients on subsequent angiogram. The mean door to IV t-pa time in ELVO positive patients with LVO was 23.20 mins (SD ±9.73) while the mean door to groin time was 73.20 mins (SD ±20.30). Mean door to reperfusion time was 135.20 mins (SD ±32.77). The sensitivity of VES was 94.74% while the specificity was 95.67%. The positive predictive value (PPV) was 69.23% while the negative predictive value (NPV) was 99.44%.ConclusionVES demonstrated reliable sensitivity, specificity, PPV and NPV and its implementation achieved target door to needle and door to groin time in patients with LVO.Abstract O-028 Table 2 VES score sheetVentura ELVO Scale ComponentsScore1) Eye deviation– Forced deviation of BOTH eyes to either side. χ Positive=1 χ Negative=0 2) Aphasia– Patient is awake but one or more of the following is present: – Unable to repeat a sentence. – Unable to name an object. – Talking gibberish and/or not following any commands. – Mute *If Aphasia positive then neglect can be evaluated by noticing if patient is not paying attention to you when you stand on one side but pay attention to you when you stand on the other side.χ Positive=1 χ Negative=0 3) Neglect– Identified by individual then simultaneous stimulus. (If patient can feel both sides individually but not feeling one side on simultaneous stimulation then its positive) χ Positive=1 χ Negative=04) Obtundation– Positive if patient is not staying awake during conversation. χ Positive=1 χ Negative=0 Ventura ELVO Score: – Maximum 4 and Minimum 0 - Score of 1 or greater is considered as ELVO Positive. DisclosuresM. Taqi:None. A. Sodhi:None. S. Suriya:None. S. Quadri:None. D. Shepherd:None. A. Salvucci:None. A. Stefansen:None.