gms | German Medical Science

Objective: After report of the usefulness of endovascular thrombectomy in acute stage of the stroke patients, the main issue to rescue the patients with stroke is to carry them to the suitable stroke center where the endovascular treatment staffs are available to do thrombectomy as short as possible. For emergency management in wide area of Hiroshima City, we started to use modified “JUST (Japan Urgent Stroke Triage) score” originally directed by Professor Yoshimura, Hyogo Medical University, from April 2019 to make suitable triage of the patients with high probability as stroke, especially as main trunk obstruction of the intracranial main arteries, LVO (large vessel occlusion). The objective was to estimate the efficacy of the JUST score handling.

Methods: We installed the application soft into the tablet and the patient’s condition boxes are checked by ambulance crew. After that, automatically the percentage of the probability of the stroke of the patient will be indicated, followed by the appearance of percentages of subtypes of the stroke. GPS function of the ambulance is combined with the location information of the stroke center will make suitable selection of the treatment location with distance between the ambulance and the stroke medical centers according to the shortness of distance and door to puncture time which are informed beforehand from the stroke center. We started clinical research to compare the outcome of such kind of patients before and after the introduction of this system. Prospective multicenter cohort study was carried out at total 13 stroke centers from April 1st, 2019 to March 30th, 2020. We investigated some issues between the periods before and after the use of JUST score.

Results: A total number of 5141 patients were enrolled in the cohort (2734 before; 2406 after). There were 1269 strokes (46.4%) including 140 LVO (5.1%), 394 ICH (intracerebral hemorrhage) (14.1%), 120 SAH (subarachnoid hemorrhage) (4.4%) and 615 CI (cerebral infarction) before use of JUST score. JUST score was used in 61.7% of the patients after implementation of JUST score, and there were 1267 strokes (52.7%) including 186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%) and 567 CI (23.6%). The success rate at the first negotiation with a stroke center was significantly increased after JUST score introduction (76.3 % vs 79.7%, p=0.004). On-scene and transport time did not significantly change after JUST score. Among patients with acute LVO, door to puncture time was significantly shortened after JUST score (84 min vs 73 min, p=0.03), but outcome was similar between two cohorts at 90 days.

Conclusion: The modified JUST system is useful for prehospital triage of the patients with stroke in acute stage. The precise data will be shown in the meeting and I would like to introduce the new system, JUST 7, as simpler prehospital triage of the patients in the acute stage of the stroke.