Abstract
We attempted to establish a Fast-Track hospital teamwork system including emergency medical services to perform swift and efficient intravenous t-PA therapy for stroke patients at the hyperacute stage. We devised a new prehospital stroke scale, TOPSPIN (TOYOTA prehospital stroke scale for t-PA intravenous therapy), as an effective triage for hyperacute stage stroke patients, especially for ischemic stroke patients with an indication for intravenous t-PA therapy, and then introduced this prehospital stroke scale into our emergency system. The TOPSPIN consists of five evaluation points: 1, consciousness; 2, atrial fibrillation; 3, language disorder; 4, hemiparesis of the upper extrenities; and 5, hemiparesis of the lower extremities. In total, 155 patients had been transported using TOPSPIN by November 6, 2007 (since December 12, 2006). The stroke diagnosis rate was 72%, including 56 cerebral infarction cases (36%), 3 TIA cases (2%), and 46 cerebral hemorrhage cases (30%); and t-PA was administered in 14 patients (9%). We also analyzed 218 stroke patients transported by our emergency medical system, and found that almost half of the cases had been transported using TOPSPIN triage. However, about half of the cases had thus been transported without TOPSPIN triage. The reasons why TOPSPIN triage was not indicated were: 1, the cases were transferred from other hospitals or medical clinics after the diagnosis as stroke; 2, they were stroke cases after the acute stage; 3, the cases were transported by emergency corps other than that of Toyota City; and 4, the cases had symptoms of only vertigo/drift/vomiting and hemianopia. TOPSPIN was demonstrated to be an effective triage system for performing swift and authentic t-PA therapy.
