STRAUMA Expedites Assessment of Stroke, Trauma to Facilitate Timely Administration of Lifesaving Interventions
By Erin Burns, PhD
VIRTUAL -- October 28, 2021 -- STRAUMA, a novel alert, allows for the expedited assessment of stroke and trauma, facilitating the timely administration of lifesaving interventions, according to a study presented at the 2021 American College of Surgeons (ACS) Clinical Congress.
“The novel STRAUMA activation allows for an expedited evaluation of both stroke and trauma to facilitate timely administration of life-saving interventions,” said Janet Lee, MD, University of Colorado Health Memorial Hospital, Colorado Springs, Colorado. “Before administering tPA [tissue plasminogen activator] for the treatment of stroke, we want to rule out any injuries such as severe head trauma, intracranial hemorrhage, or bleeding risk that could cause catastrophic bleeding.”
The researchers evaluated the STRAUMA alert on 580 adult patients presenting with signs of a cerebrovascular accident to a Level I trauma and comprehensive stroke center between January 2019 and September 2020. Patients were included if there was a stroke alert or a STRAUMA alert within 15 minutes of their arrival at the center.
STRAUMA activation enables the emergency department team and trauma team to assess the patient with stroke symptoms and signs of trauma first in order to identify a traumatic injury. If serious injury is not found, the patient can go for immediate CT scanning to confirm stroke.
Of the 580 identified patients, 469 had a stroke alert and 111 had a STRAUMA alert. No significant differences in anticoagulation use, age, or sex were identified between the stroke alert group and the STRAUMA alert group.
The stroke alert group had a shorter time-to-CT than the STRAUMA activation group (17 vs 23 minutes).
The rate of tPA administration was higher in the stroke alert group than the STRAUMA group (27.9% vs 13.5%).
“The reason is because there were fewer stroke diagnoses in the STRAUMA group,” noted Dr. Lee.
The rate of thrombectomy was similar between the STRAUMA and stroke alert group (8.1% vs 9%). Overall, no differences were seen in time-to-tPA and time-to-thrombectomy in the stroke alert group and the STRAUMA group.
The overall percentage of the STRAUMA patients who had a traumatic injury was 15%, with an average injury severity score (ISS) of 9.
The STRAUMA group had a higher mortality rate than the stroke alert group (14.4% vs 6%). After a multivariable analysis, NIH Stroke Scale and time-to-CT were predictors of mortality. The STRAUMA activation did not increase risk of mortality.
“The STRAUMA activation added 6 minutes to the overall process, whereas the stroke alert group had a shorter time-to-CT,” said Dr. Lee. “It’s all about risk versus benefit. The risk of patients with trauma getting tPA and having catastrophic bleeding outweighs the risk of a slight delay in CT scanning. And our results ultimately show that in all patients who did get tPA, no differences were seen in time-to-tPA.”
[Presentation title: STRAUMA Alert: A Novel Alert System for a Combined Stroke and Trauma. Scientific Forum Presentation]