2017 Volume 45 Issue 1 Pages 31-39
The Kawasaki City Emergency Team used the Maria Prehospital Stroke Scale (MPSS) developed in our hospital to perform prehospital triage on stroke patients and undertake bypass transportation with the intent of administering intravenous tissue plasminogen activator (tPA) therapy. This study aimed to compare treatment results for citywide MPSS transportation cases with the results of intravenous tPA therapy in our hospital Stroke Care Unit (SCU) and to clarify future issues. Subjects comprised 1545 cerebral infarction patients admitted to our hospital during the 6 years from 2010 through 2015, and 89 patients who underwent intravenous tPA therapy. We also analyzed and compared treatment results for 4429 cases of Kawasaki citywide MPSS transportation. Intravenous tPA therapy was performed in 5.8% of all patients with cerebral infarction admitted to our hospital and in 23.1% of patients with cerebral infarction undergoing MPSS transportation. National Institutes of Health Stroke Scale (NIHSS) score was significantly improved at around 24 h after tPA administration, and a modified Rankin Scale (mRS) score of 0-1 was achieved at discharge in 31.4% of patients at 13 Kawasaki Stroke Network facilities and in 36.4% of patients at our SCU. Comparison of patients who underwent intravenous tPA therapy between the MPSS transportation group (n = 55) and the other group (n = 34) found a shorter time from onset to intravenous tPA injection and a higher frequency of achieving a mRS score of 0-1 at discharge in the MPSS transportation group. To improve the performance of comprehensive stroke centers, continued post-verification study is needed of in-hospital multidisciplinary collaboration and emergency services involved in MPSS transportation. Further training of personnel involved in stroke treatment will also be important.
