2024
Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study
Dhand A, Reeves M, Mu Y, Rosner B, Rothfeld-Wehrwein Z, Nieves A, Dhongade V, Jarman M, Bergmark R, Semco R, Ader J, Marshall B, Goedel W, Fonarow G, Smith E, Saver J, Schwamm L, Sheth K. Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study. Stroke 2024, 55: 1507-1516. PMID: 38787926, PMCID: PMC11299104, DOI: 10.1161/strokeaha.123.045521.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEmergency Medical ServicesFemaleHumansIschemic StrokeMaleMiddle AgedRegistriesStrokeTime-to-TreatmentUnited StatesConceptsSocial Vulnerability IndexPrehospital delayHospital arrivalZIP Code Tabulation AreasEmergency medical servicesCommunity-level social vulnerabilityGuidelines-Stroke registryCommunity socioeconomic statusCommunity-level factorsPatient-level factorsNationwide registry studyAmerican Heart AssociationSocial vulnerabilityCox proportional hazards modelsSocially vulnerable areasAssociated with delaySocial determinantsProportional hazards modelAcute stroke treatmentGeospatial mappingSocioeconomic statusMedical servicesIncreased social vulnerabilityPrimary exposureQuartile 3
2022
Estimated Population Access to Acute Stroke and Telestroke Centers in the US, 2019
Zachrison K, Cash R, Adeoye O, Boggs K, Schwamm L, Mehrotra A, Camargo C. Estimated Population Access to Acute Stroke and Telestroke Centers in the US, 2019. JAMA Network Open 2022, 5: e2145824. PMID: 35138392, PMCID: PMC8829668, DOI: 10.1001/jamanetworkopen.2021.45824.Peer-Reviewed Original ResearchMeSH KeywordsCritical CareCross-Sectional StudiesEmergency Medical ServicesHealth Services AccessibilityHumansStrokeTelemedicineUnited States
2021
Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society
Jauch E, Schwamm L, Panagos P, Barbazzeni J, Dickson R, Dunne R, Foley J, Fraser J, Lassers G, Martin-Gill C, O’Brien S, Pinchalk M, Prabhakaran S, Richards C, Taillac P, Tsai A, Yallapragada A, Conference O. Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society. Stroke 2021, 52: e133-e152. PMID: 33691507, DOI: 10.1161/strokeaha.120.033228.Peer-Reviewed Original ResearchMeSH KeywordsAmerican Heart AssociationConsensusEmergency Medical ServicesHumansRural PopulationStrokeUnited StatesUrban PopulationConceptsAmerican Heart Association/American Stroke AssociationSociety of VascularAmerican Stroke AssociationNeurocritical Care SocietyState EMS OfficialsInterventional NeurologyStroke AssociationStroke systemsConsensus statementConsensus conferenceNeurointerventional surgeryAmerican AcademyEMS physiciansAmerican SocietyNeurologyAssociationNational AssociationUrban communitiesSurgeryVascular
2019
Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association
Adeoye O, Nyström K, Yavagal D, Luciano J, Nogueira R, Zorowitz R, Khalessi A, Bushnell C, Barsan W, Panagos P, Alberts M, Tiner A, Schwamm L, Jauch E. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association. Stroke 2019, 50: e187-e210. PMID: 31104615, DOI: 10.1161/str.0000000000000173.Peer-Reviewed Original ResearchMeSH KeywordsCertificationEmergency Medical ServicesHumansOrganizational PolicyPractice Guidelines as TopicSocieties, MedicalStrokeUnited StatesConceptsAmerican Stroke AssociationStroke systemsStroke AssociationStroke center certificationMobile stroke unitEmergency medical servicesHospital dischargeSecondary preventionStroke centersEndovascular therapyStroke unitPrimary preventionCenter certificationNeurocritical careAssociation recommendationsCareBasis of improvementStroke recognitionMedical servicesHealthcare agenciesScientific evidenceHealthcare policyAppropriate facilitiesPreventionSignificant changesStroke Treatment Academic Industry Roundtable X
Savitz S, Baron J, Fisher M, Albers G, Arbe-Barnes S, Boltze J, Broderick J, Broschat K, Elkind M, En’Wezoh D, Furlan A, Gorelick P, Grotta J, Hancock A, Hess D, Holt W, Houser G, Hsia A, Kim W, Korinek W, Le Moan N, Liberman M, Lilienfeld S, Luby M, Lynch J, Mansi C, Simpkins A, Nadareishvili Z, Nogueira R, Pryor K, Sanossian N, Schwamm L, Selim M, Sheth K, Spilker J, Solberg Y, Steinberg G, Stice S, Tymianski M, Wechsler L, Yoo A. Stroke Treatment Academic Industry Roundtable X. Stroke 2019, 50: 1026-1031. PMID: 31166683, DOI: 10.1161/strokeaha.118.023927.Peer-Reviewed Original Research
2018
Optimization of Prehospital Triage of Patients With Suspected Ischemic Stroke
Ali A, Zachrison K, Eschenfeldt P, Schwamm L, Hur C. Optimization of Prehospital Triage of Patients With Suspected Ischemic Stroke. Stroke 2018, 49: 2532-2535. PMID: 30355100, PMCID: PMC6205725, DOI: 10.1161/strokeaha.118.022041.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaEmergency Medical ServicesFemaleHumansIschemiaMaleQuality of LifeSeverity of Illness IndexStrokeThrombolytic TherapyTriageConceptsMathematical modelMathematical decision modelMultiple parameter setsOptimal strategyProportion of runsModel input parametersParameter setsInput parametersTimeliness performanceTraffic patternsModel predictionsModel sensitivityIterationModelOptimizationPlausible rangeTransport timeRouting algorithmAlgorithm
2016
Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care
Rumsfeld J, Brooks S, Aufderheide T, Leary M, Bradley S, Nkonde-Price C, Schwamm L, Jessup M, Ferrer J, Merchant R. Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care. Circulation 2016, 134: e87-e108. PMID: 27334603, DOI: 10.1161/cir.0000000000000428.Peer-Reviewed Original Research
2015
Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines–Stroke Registry
Mochari-Greenberger H, Xian Y, Hellkamp A, Schulte P, Bhatt D, Fonarow G, Saver J, Reeves M, Schwamm L, Smith E. Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines–Stroke Registry. Journal Of The American Heart Association 2015, 4: e002099. PMID: 26268882, PMCID: PMC4599467, DOI: 10.1161/jaha.115.002099.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsianBlack or African AmericanChi-Square DistributionEmergency Medical ServicesFemaleHealth Knowledge, Attitudes, PracticeHispanic or LatinoHospitalizationHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient Acceptance of Health CareRegistriesSex FactorsStrokeTransportation of PatientsUnited StatesWhite PeopleConceptsEmergency medical servicesStroke patientsStroke symptomsEMS useRace/ethnicityHospitalized acute stroke patientsEmergency medical services transportWhite womenGuidelines-Stroke registryAcute stroke patientsMultivariable logistic regressionLevel of consciousnessSex differencesGuidelines-StrokeNational GetIschemic strokeStroke outcomePatient characteristicsPotential confoundersMedical historyEMS transportSex disparitiesPatientsHispanic menLogistic regressionDrip and Ship Thrombolytic Therapy for Acute Ischemic Stroke
Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Stroke 2015, 46: 732-739. PMID: 25672784, DOI: 10.1161/strokeaha.114.007506.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorSymptomatic intracranial hemorrhageTPA useAcute strokeIschemic strokeIntracranial hemorrhageHealth Stroke Scale scoreReal-world practice patternsGuidelines-Stroke programStroke Scale scoreAcute ischemic strokeCharacteristics of patientsLower National InstitutesPatient selection biasConventional thrombolysisHospital mortalityHospital outcomesSymptom onsetInterhospital transferThrombolytic therapyHospital characteristicsPractice patternsShip paradigmMAIN OUTCOME
2014
Improving Door-to-Needle Times
Ruff I, Ali S, Goldstein J, Lev M, Copen W, McIntyre J, Rost N, Schwamm L. Improving Door-to-Needle Times. Stroke 2014, 45: 504-508. PMID: 24399372, DOI: 10.1161/strokeaha.113.004073.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overClinical ProtocolsComorbidityData Interpretation, StatisticalEarly DiagnosisEmergency Medical ServicesFemaleFibrinolytic AgentsHumansInternational Classification of DiseasesMaleMiddle AgedProspective StudiesQuality ImprovementRetrospective StudiesSocioeconomic FactorsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsIntravenous tissue-type plasminogen activatorEmergency department arrivalTissue-type plasminogen activatorAcute strokeDTN timeNeedle timeHealth Stroke Scale scorePlasminogen activatorAcute ischemic strokePercentage of patientsStroke Scale scoreAmerican Heart AssociationStroke care modelWilcoxon signed-rank testImproving DoorIschemic strokeStroke guidelinesHeart AssociationPostintervention periodSigned-rank testPre interventionCare modelNational guidelinesPost interventionPatients
2013
Review of Stroke Center Effectiveness and Other Get with the Guidelines Data
Silva G, Schwamm L. Review of Stroke Center Effectiveness and Other Get with the Guidelines Data. Current Atherosclerosis Reports 2013, 15: 350. PMID: 23892766, DOI: 10.1007/s11883-013-0350-8.Peer-Reviewed Original ResearchMeSH KeywordsEmergency Medical ServicesEvidence-Based PracticeHospitals, SpecialHumansLong-Term CarePractice Guidelines as TopicStrokeStroke RehabilitationUnited StatesConceptsStroke systemsAcute careAcute stroke-ready hospitalGuidelines-Stroke programSpectrum of strokeStroke-ready hospitalsComprehensive stroke centerBest evidence-based careEvidence-based careAmerican Heart AssociationEmergency medical servicesSecondary preventionStroke centersStroke carePrimary preventionHeart AssociationCoordinated careCare processesPatient accessCareCare comprisesStrokeMedical servicesPreventionGuideline dataPatterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment
Ekundayo O, Saver J, Fonarow G, Schwamm L, Xian Y, Zhao X, Hernandez A, Peterson E, Cheng E. Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment. Circulation Cardiovascular Quality And Outcomes 2013, 6: 262-269. PMID: 23633218, DOI: 10.1161/circoutcomes.113.000089.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overChi-Square DistributionEmergency Medical ServicesEmergency Service, HospitalEthnicityFemaleGuideline AdherenceHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedMinority GroupsOdds RatioOutcome and Process Assessment, Health CarePatient Acceptance of Health CarePatient Education as TopicPractice Guidelines as TopicRegistriesRisk FactorsStrokeTime FactorsTime-to-TreatmentTransportation of PatientsTreatment OutcomeUnited StatesConceptsEmergency medical servicesStroke patientsEMS useEmergency medical services useMinority raceHealth Stroke ScoreMedical service useTreatment of strokeTissue-type plasminogen activatorEligible patientsGuidelines-StrokeSevere strokeStroke ScoreHospital arrivalOlder patientsYounger patientsHemorrhagic strokeStroke treatmentMedicare insuranceInsurance statusEMS activationDecreased oddsEMS transportService usePatients
2012
Have CT—will travel
Schwamm L, Starkman S. Have CT—will travel. Neurology 2012, 80: 130-131. PMID: 23223538, DOI: 10.1212/wnl.0b013e31827d44ca.Peer-Reviewed Original ResearchEmergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke
Lin C, Peterson E, Smith E, Saver J, Liang L, Xian Y, Olson D, Shah B, Hernandez A, Schwamm L, Fonarow G. Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2012, 5: 514-522. PMID: 22787065, DOI: 10.1161/circoutcomes.112.965210.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCommunicationEmergency Medical ServicesEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHealth Services AccessibilityHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality ImprovementRegistriesStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic strokeTissue plasminogen activatorNeedle timeEMS prenotificationHospital prenotificationIschemic strokeEligible patientsShorter doorIntravenous tissue plasminogen activatorClustering of patientsShorter symptom onsetQuality of careGuidelines-StrokeTPA useSymptom onsetPotential strokeStroke treatmentPatientsPoisson regressionStrokeTreatment ratesIncoming patientsGreater likelihoodPrenotificationMinutesTimes From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009
Tong D, Reeves M, Hernandez A, Zhao X, Olson D, Fonarow G, Schwamm L, Smith E. Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009. Stroke 2012, 43: 1912-1917. PMID: 22539544, DOI: 10.1161/strokeaha.111.644963.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualEmergency Medical ServicesEmergency Service, HospitalHumansMiddle AgedPractice Guidelines as TopicStrokeTime FactorsConceptsAcute ischemic strokeIschemic strokeSymptom onsetDoor timeHospital arrivalIntravenous tissue-type plasminogen activatorAcute ischemic stroke therapyEmergency medical services transportFourth of patientsGuidelines-Stroke programProportion of patientsHospital arrival timeIschemic stroke therapyPlasminogen activator therapyPortion of patientsTissue-type plasminogen activatorEligible patientsStroke therapyActivator therapyAcute interventionNationwide studyTreatment windowPatientsEarly onsetStroke
2011
A Qualitative Assessment of Practices Associated With Shorter Door-to-Needle Time for Thrombolytic Therapy in Acute Ischemic Stroke
Olson D, Constable M, Britz G, Lin C, Zimmer L, Schwamm L, Fonarow G, Peterson E. A Qualitative Assessment of Practices Associated With Shorter Door-to-Needle Time for Thrombolytic Therapy in Acute Ischemic Stroke. Journal Of Neuroscience Nursing 2011, 43: 329-336. PMID: 22089410, DOI: 10.1097/jnn.0b013e318234e7fb.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeNeedle timeIschemic strokeStroke patientsGoal of doorQualitative telephone interviewsThrombolytic therapyEarly treatmentImproved outcomesTPA deliveryRapid triageHermeneutic phenomenological frameworkTelephone interviewsPatientsU.S. hospitalsStrokeHospitalFaster treatmentTreatmentNovel factorOvercoming barriersElicit strategiesAlteplaseQualitative assessmentTherapyImproving Door-to-Needle Times in Acute Ischemic Stroke
Fonarow G, Smith E, Saver J, Reeves M, Hernandez A, Peterson E, Sacco R, Schwamm L. Improving Door-to-Needle Times in Acute Ischemic Stroke. Stroke 2011, 42: 2983-2989. PMID: 21885841, DOI: 10.1161/strokeaha.111.621342.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeAcute ischemic stroke patientsTissue-type plasminogen activatorIschemic stroke patientsNeedle timeIschemic strokeStroke patientsAmerican Heart Association/American Stroke AssociationIntravenous tissue-type plasminogen activatorAmerican Stroke AssociationUnited States hospitalsEmergency medical services prenotificationInitial program goalsTeam-based approachImproving DoorStroke teamTPA administrationFaster doorStroke AssociationClinical practiceHospital participationState HospitalStrokePatientsPlasminogen activatorTimeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke
Fonarow G, Smith E, Saver J, Reeves M, Bhatt D, Grau-Sepulveda M, Olson D, Hernandez A, Peterson E, Schwamm L. Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke. Circulation 2011, 123: 750-758. PMID: 21311083, DOI: 10.1161/circulationaha.110.974675.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overAmerican Heart AssociationBrain IschemiaEmergency Medical ServicesFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome Assessment, Health CarePractice Guidelines as TopicRisk FactorsStrokeTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorIschemic stroke patientsNeedle timeIschemic strokeStroke patientsAcute ischemic stroke patientsGuidelines-Stroke programSimilar stroke severitySymptomatic intracranial hemorrhageTimeliness of reperfusionProportion of patientsPlasminogen activator therapyTreatment initiation timeMinute doorPrior strokeHospital mortalityHospital factorsStroke severitySymptom onsetPatient factorsActivator therapyIntracranial hemorrhageHospital characteristics
2010
The “Golden Hour” and Acute Brain Ischemia
Saver J, Smith E, Fonarow G, Reeves M, Zhao X, Olson D, Schwamm L. The “Golden Hour” and Acute Brain Ischemia. Stroke 2010, 41: 1431-1439. PMID: 20522809, PMCID: PMC2909671, DOI: 10.1161/strokeaha.110.583815.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsHospital emergency departmentIntravenous thrombolytic therapyAcute brain ischemiaNeedle timeThrombolytic therapyStroke patientsEmergency departmentGolden hourBrain ischemiaGreater stroke severityGuidelines-Stroke databaseQuarter of patientsHours of onsetHours patientsStroke severityDoor timeEarly presentationPatientsWell timeStudy periodTherapyIschemiaOnset timeMinutes
2009
Influence of stroke subtype on quality of care in the Get With The Guidelines–Stroke Program
Smith E, Liang L, Hernandez A, Reeves M, Cannon C, Fonarow G, Schwamm L. Influence of stroke subtype on quality of care in the Get With The Guidelines–Stroke Program. Neurology 2009, 73: 709-716. PMID: 19720978, PMCID: PMC2734292, DOI: 10.1212/wnl.0b013e3181b59a6e.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCerebral HemorrhageEmergency Medical ServicesFemaleGuideline AdherenceHospitalsHumansMaleMiddle AgedOutcome Assessment, Health CarePractice Guidelines as TopicQuality Assurance, Health CareQuality of Health CareRisk Reduction BehaviorSmoking CessationStrokeSubarachnoid HemorrhageUnited StatesVenous ThrombosisConceptsQuality of careIS/TIAIntracerebral hemorrhageIschemic strokeStroke subtypesTIA admissionsHemorrhagic strokeCare measuresDeep venous thrombosis preventionHospital-based acute careGuidelines-Stroke databaseGuidelines-Stroke programGWTG-Stroke programVenous thrombosis preventionSmoking cessation therapyMeasures of careLogistic regression modelsDVT preventionIneligible patientsNational GetDysphagia screeningCessation therapySAH patientsAcute careICH patients