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Flores A, Garcia-Tornel A, Seró L, Ustrell X, Requena M, Pellisé A, Rodriguez P, Monterde A, Lara L, Gonzalez-de-Echavarri JM, Molina CA, Doncel-Moriano A, Dorado L, Cardona P, Cánovas D, Krupinski J, Más N, Purroy F, Zaragoza-Brunet J, Palomeras E, Cocho D, Garcia J, Colom C, Silva Y, Gomez-Cocho M, Jiménez X, Ros-Roig J, Abilleira S, Pérez de la Ossa N, Ribo M. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis. J Neurointerv Surg 2024; 16:143-150. [PMID: 37068936 DOI: 10.1136/jnis-2023-020125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
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Affiliation(s)
- Alan Flores
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | | | - Laia Seró
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Xavier Ustrell
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Pellisé
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Paula Rodriguez
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Angela Monterde
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Lidia Lara
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Jose María Gonzalez-de-Echavarri
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Doncel-Moriano
- Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Pedro Cardona
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - David Cánovas
- Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain
| | | | - Natalia Más
- Department of Neurology, Hospital Althaia, Manresa, Manresa, Catalunya, Spain
| | | | - Jose Zaragoza-Brunet
- Stroke Unit, Department of Neurology, Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
| | - Ernesto Palomeras
- Department of Neurology, Hospital de Mataró, Mataro, Catalunya, Spain
| | - Dolores Cocho
- Department of Neurology, Hospital General de Granollers, Granollers, Catalunya, Spain
| | - Jessica Garcia
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedes, Catalunya, Spain
| | - Carla Colom
- Department of Neurology, Hospital Universitario de Igualada, Igualada, Catalunya, Spain
| | - Yolanda Silva
- Neurology Department, Stroke Unit, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | - Manuel Gomez-Cocho
- Department of Neurology, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Josep Ros-Roig
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Sonia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
- Catalan Stroke Program, Barcelona, Spain
| | - Marc Ribo
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Silva Y, Sánchez-Cirera L, Terceño M, Dorado L, Valls A, Martínez M, Abilleira S, Rubiera M, Quesada H, Llull L, Rodríguez-Campello A, Martí-Fàbregas J, Seró L, Purroy F, Payo I, García S, Cánovas D, Krupinski J, Mas N, Palomeras E, Cocho D, Font MÀ, Catena E, Puiggròs E, Pedroza C, Marín G, Carrión D, Costa X, Almendros MC, Torres I, Colom C, Velasquez JA, Diaz G, Jiménez X, Subirats T, Deulofeu A, Hidalgo V, Salvat-Plana M, Pérez de la Ossa N. Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia. Eur Stroke J 2023; 8:557-565. [PMID: 37231687 PMCID: PMC10334164 DOI: 10.1177/23969873231156260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22). DISCUSSION AND CONCLUSION We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.
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Affiliation(s)
| | | | | | - Laura Dorado
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Adrián Valls
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marina Martínez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Marta Rubiera
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Helena Quesada
- Hospital Universitari de Bellvitge, L’Hospitalet de llobregat, Spain
| | - Laura Llull
- Hospital Clínic of Barcelona, Barcelona, Spain
| | | | | | - Laia Seró
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Iago Payo
- Hospital Verge de la Cinta, Tortosa, Spain
| | - Sònia García
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | | | | | | | | | | | | | - Esther Catena
- Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mercè Salvat-Plana
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
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Olivé-Gadea M, Pérez de la Ossa N, Jovin T, Abilleira S, Jiménez X, Cardona P, Chamorro A, Flores A, Silva Y, Purroy F, Martí-Fabregas J, Rodríguez-Campello A, Zaragoza J, Krupinski J, Canovas D, Gomez Choco M, Mas N, Palomeras E, Cocho D, Aragonès JM, Repullo C, Sanjurjo E, Carrion D, Catena E, Costa X, Almendros MC, Barceló M, Monedero J, Rybyeva M, Diaz G, Ribó M. Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population. Int J Stroke 2023; 18:229-236. [PMID: 35373657 DOI: 10.1177/17474930221093523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC. AIMS To analyze the evolution of performance indicators in the regions that participated in RACECAT. METHODS This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020). RESULTS We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001). CONCLUSION An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.
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Affiliation(s)
- Marta Olivé-Gadea
- Stroke Unit, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Tudor Jovin
- Neurology Department, Cooper University Health Care, Camden, NJ, USA
| | - Sonia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain
| | | | - Alan Flores
- Stroke Unit, Hospital Joan XIII, Tarragona, Spain
| | | | | | | | | | - Josep Zaragoza
- Neurology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Jerzy Krupinski
- Neurology Department, Hospital Mútua Terrassa, Terrassa, Spain
| | - David Canovas
- Neurology Department, Hospital Parc Tauli, Sabadell, Spain
| | | | - Natalia Mas
- Neurology Department, Althaia Xarxa Assistencial Universitària, Manresa, Spain
| | | | - Dolores Cocho
- Neurology Department, Hospital General de Granollers, Granollers, Spain
| | | | - Carmen Repullo
- Neurology Department, Fundació Sant Hospital, La Seu d'Urgell, Spain
| | - Eduard Sanjurjo
- Neurology Department, Hospital Comarcal del Pallars, Tremp, Spain
| | - Dolores Carrion
- Emergency Department, Hospital de Móra d'Ebre, Móra d'Ebre, Spain
| | - Esther Catena
- Neurology Department, Consorci Sanitari Alt Penedès-Garraf, Spain
| | - Xavier Costa
- Emergency Department, Hospital de Figueres, Figueres, Spain
| | | | - Miquel Barceló
- Emergency Department, Hospital de Cerdanya, Puigcerdà, Spain
| | | | | | - Gloria Diaz
- Emergency Department, Hospital de Campdevànol, Campdevànol, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Garcia-Tornel A, Millan M, Rubiera M, Bustamante A, Requena M, Dorado L, Olivé-Gadea M, Jiménez X, Soto A, Querol M, Hernández-Pérez M, Gomis M, Cardona P, Urra X, Purroy F, Silva Y, Ustrell X, Esteve P, Salvat-Plana M, Gallofré M, Molina C, Dávalos A, Jovin T, Abilleira S, Ribo M, Pérez de la Ossa N. Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas. Stroke 2022; 53:3728-3740. [PMID: 36259411 DOI: 10.1161/strokeaha.122.040768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). METHODS Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. RESULTS The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2-5] versus 3 [1-5], common odds ratio, 1.25 [95% CI, 1.06-1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08-1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81-1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16-1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51-0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25-52]) and thrombectomy(mean difference 66 minutes [95% CI, 37-95]). CONCLUSIONS In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02795962.
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Affiliation(s)
- Alvaro Garcia-Tornel
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Monica Millan
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Marta Rubiera
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Alejandro Bustamante
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Manuel Requena
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Laura Dorado
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Marta Olivé-Gadea
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | - Angels Soto
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | - Marisol Querol
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | | | - Meritxell Gomis
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain (P.C.)
| | - Xabier Urra
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U.)
| | - Francesc Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova de Lleida, Lleida, IRBLleida, UdL, Spain (F.P.)
| | - Yolanda Silva
- Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain (Y.S.)
| | - Xavier Ustrell
- Department of Neurology, Stroke Unit, Hospital Joan XXIII, Tarragona, Spain (X.U.)
| | - Patricia Esteve
- Department of Neurology, Stroke Unit, Hospital Verge de la Cinta, Tortosa, Spain (P.E.)
| | - Mercè Salvat-Plana
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
| | | | - Carlos Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | | | - Tudor Jovin
- Neurological Institute, Cooper University Hospital, Camden, New Jersey (T.J.)
| | | | - Marc Ribo
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Natalia Pérez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.).,Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
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Trenado J, Solà S, Campos O, Morales JA, Azeli Y, Jiménez X. [Transfer support and coordination of critical patients during the COVID-19 pandemic by a regional command center]. Med Intensiva 2022; 47:293-295. [PMID: 36248279 PMCID: PMC9554337 DOI: 10.1016/j.medin.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J Trenado
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, España
| | - S Solà
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, España
| | - O Campos
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, España
| | - J A Morales
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, España
| | - Y Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, España
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, España
| | - X Jiménez
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España; Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, España
- Universitat de Barcelona, Barcelona, España
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Solà-Muñoz S, Azeli Y, Trenado J, Jiménez X, Bisbal R, López À, Morales J, García X, Sánchez B, Fernández J, Soto MÁ, Ferreres Y, Cantero C, Jacob J. Effect of a Prioritization Score on the Inter-Hospital Transfer Time Management of Severe COVID-19 Patients. A Quasi-Experimental Intervention Study. Int J Qual Health Care 2022; 34:6548674. [PMID: 35289365 PMCID: PMC8992311 DOI: 10.1093/intqhc/mzac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background The overburdening of the healthcare system during the coronavirus disease 19 (COVID-19) pandemic is driving the need to create new tools to improve the management of inter-hospital transport for patients with a severe COVID-19 infection. Objective The aim of this study was to analyse the usefulness of the application of a prioritization score (IHTCOVID-19) for inter-hospital transfer of patients with COVID-19 infection. Methods The study has a quasi-experimental design and was conducted on the Medical Emergency System, the pre-hospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with a severe COVID-19 infection requiring inter-hospital transport were consecutively included. The pre-intervention period was from 1 to 31 March 2020, and the intervention period with the IHTCOVID-19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritization score comprises four priority categories, with Priority 0 being the highest and Priority 3 being the lowest. Inter-hospital transfer (IHT) management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID-19 score was applied. Results A total of 344 IHTs were included: 189 (54.9%) in the pre-intervention period and 155 (45.1%) in the post-intervention period. The majority of patients were male and the most frequent age range was between 50 and 70 years. According to the IHTCOVID-19 score, 12 (3.5%) transfers were classified as Priority 0, 66 (19.4%) as Priority 1, 247 (71.8%) as Priority 2 and 19 (5.6%) as Priority 3. Overall, with the application of the IHTCOVID-19 score, there was a significant reduction in total central management time [from 112.4 (inter-quartile range (IQR) 281.3) to 89.8 min (IQR 154.9); P = 0.012]. This significant reduction was observed in Priority 0 patients [286.2 (IQR 218.5) to 42.0 min (IQR 58); P = 0.018] and Priority 1 patients [130.3 (IQR 297.3) to 75.4 min (IQR 91.1); P = 0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 min, and variability was reduced from 618.1 to 324.0 min. Conclusion The application of the IHTCOVID-19 score in patients with a severe COVID-19 infection reduces IHT management times and variability.
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Affiliation(s)
- Silvia Solà-Muñoz
- Address reprint requests to: Silvia Solà-Muñoz, Area of Research and Development, Sistema d’Emergències Mèdiques, Pablo Iglesias 101-115, L’Hospitalet de Llobregat, Barcelona 08908, Spain. Tel: +34 93 264 44 00; E-mail:
| | - Youcef Azeli
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain
- Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili (IISPV), Avda, Josep Laporte, 2 Planta 0 – E2 color taronja, Reus, Tarragona 43204, Spain
| | - Josep Trenado
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Intensive Care Unit, Hospital Universitari Mutua de Terrassa, Plaça del Doctor Robert, 5, Terrassa, Barcelona 08221, Spain
| | - Xavier Jiménez
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain
| | - Roger Bisbal
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Àngels López
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Jorge Morales
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Xaime García
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Bernat Sánchez
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - José Fernández
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Av. Colom 16-20, Tortosa, Tarragona 43500, Spain
- Unidat de Recerca, Gerència Territorial Terres de l´Ebre, Institut Català de la Salut, Ctra. de la Simpàtica, 44, Tortosa, Tarragona 43500, Spain
| | - Maria Ángeles Soto
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Yolanda Ferreres
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Cristina Cantero
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Javier Jacob
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Universitat de Barcelona, Carrer de la Feixa Llarga, s/n, Barcelona 08907, Spain
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7
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Abilleira S, Pérez de la Ossa N, Jiménez X, Cardona P, Cocho D, Purroy F, Serena J, Román LS, Urra X, Vilaró M, Cortés J, González JA, Chamorro Á, Gallofré M, Jovin T, Molina C, Cobo E, Dávalos A, Ribó M. Transfer to the Local Stroke Center versus Direct Transfer to Endovascular Center of Acute Stroke Patients with Suspected Large Vessel Occlusion in the Catalan Territory (RACECAT): Study protocol of a cluster randomized within a cohort trial. Int J Stroke 2019; 14:734-744. [PMID: 31142219 DOI: 10.1177/1747493019852176] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
RATIONALE Optimal pre-hospital delivery pathways for acute stroke patients suspected to harbor a large vessel occlusion have not been assessed in randomized trials. AIM To establish whether stroke subjects with rapid arterial occlusion evaluation scale based suspicion of large vessel occlusion evaluated by emergency medical services in the field have higher rates of favorable outcome when transferred directly to an endovascular center (endovascular treatment stroke center), as compared to the standard transfer to the closest local stroke center (local-SC). DESIGN Multicenter, superiority, cluster randomized within a cohort trial with blinded endpoint assessment. PROCEDURE Eligible patients must be 18 or older, have acute stroke symptoms and not have an immediate life threatening condition requiring emergent medical intervention. They must be suspected to have intracranial large vessel occlusion based on a pre-hospital rapid arterial occlusion evaluation scale of ≥5, be located in geographical areas where the default health authority assigned referral stroke center is a non-thrombectomy capable hospital, and estimated arrival at a thrombectomy capable stroke hospital in less than 7 h from time last seen well. Cluster randomization is performed according to a pre-established temporal sequence (temporal cluster design) with three strata: day/night, distance to the endovascular treatment stroke center, and week/week-end day. STUDY OUTCOME The primary endpoint is the modified Rankin Scale score at 90 days. The primary safety outcome is mortality at 90 days. ANALYSIS The primary endpoint based on the modified intention-to-treat population is the distribution of modified Rankin Scale scores at 90 days analyzed under a sequential triangular design. The maximum sample size is 1754 patients, with two planned interim analyses when 701 (40%) and 1227 patients have completed follow-up. Hypothesized common odds ratio is 1.35.
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Affiliation(s)
- Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain
| | | | - Francisco Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova, Lleida, Spain
| | - Joaquín Serena
- Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain
| | - Luis San Román
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
| | - Xabier Urra
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Marta Vilaró
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Cortés
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - José Antonio González
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ángel Chamorro
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Miquel Gallofré
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Tudor Jovin
- Department of Neurological Surgery, Pierre and Marie Curie University, Pittsburgh, PA, USA
| | - Carlos Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain Sònia Abilleira, Natalia Pérez de la Ossa and Marc Ribó contributed equally to this article
| | - Erik Cobo
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Antoni Dávalos
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marc Ribó
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain Sònia Abilleira, Natalia Pérez de la Ossa and Marc Ribó contributed equally to this article
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8
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Carrera D, Gorchs M, Querol M, Abilleira S, Ribó M, Millán M, Ramos A, Cardona P, Urra X, Rodríguez-Campello A, Prats-Sánchez L, Purroy F, Serena J, Cánovas D, Zaragoza-Brunet J, Krupinski JA, Ustrell X, Saura J, García S, Mora MÀ, Jiménez X, Dávalos A, Pérez de la Ossa N. Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion. J Neurointerv Surg 2018; 11:751-756. [PMID: 30580284 DOI: 10.1136/neurintsurg-2018-014519] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/04/2022]
Abstract
Background and purposeOur aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT).MethodsWe used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC).ResultsThe RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, P<0.001). A RACE score ≥5 detected LVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (OR 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter.ConclusionsThis large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.
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Affiliation(s)
- David Carrera
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Montse Gorchs
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | | | - Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Marc Ribó
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Anna Ramos
- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Xabier Urra
- Hospital Clínic, Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
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9
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Perez de la Ossa N, Abilleira S, Ribó M, Monica M, Cardona P, Urra X, Rodríguez-Campello A, Martí-Fábregas J, Purroy F, Serena J, Cánovas D, Garcés M, Krupinski J, Ustrell X, Saura J, Gorchs M, Carrera D, Jiménez X, Dávalos A. Abstract 18: External Validation of the RACE Scale After Its Implementation in the Stroke Code Protocol in Catalonia. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
We aimed to revalidate the RACE scale as a pre-hospital tool to identify patients with large vessel occlusion (LVO) and patients receiving endovascular treatment (EVT) after its implementation in the Stroke Code protocol of Catalonia (7.5 M inhabitants).
Methods:
We used data from the CICAT registry (Feb to Jun 2016), a government-mandated, prospective, hospital-based dataset that includes all Stroke Code activations. CICAT is linked to the EMS database to capture information about the pre-hospital care. RACE score, pre-hospital and in-hospital delays, final diagnostic, presence of LVO (TICA, MCA M1 or M2, tandem or basilar occlusion) and revascularization treatment were registered. Sensitivity, specificity and area under the curve (AUC) to identify LVO and patients receiving EVT were calculated for the pre-established cut off RACE≥5.
Results:
From the 1600 stroke code activations we included in the study the 962 patients in which the RACE scale was available (60%). The RACE scale showed a strong correlation with the NIHSS evaluated at hospital arrival (r=0.74, p<0.001). Distribution of final diagnosis and median RACE scores were: ischemic with LVO (22.1%), RACE 7 [5-8], ischemic without LVO (29.3%), RACE 3 [2-5], hemorrhagic(17.8%), RACE 6 [4-7], mimic(21.0%), RACE 2 [1-4] and transient ischemic attack(9.7%), RACE 3 [1-5]. A RACE cut-off score ≥5 showed sensitivity 0.80 and specificity 0.63 to detect LVO (AUC 0.78, Youden index 0.45), similar to results obtained in the validation study. In patients with RACE≥5 the rates of LVO (42% Vs 9%;p<0.001) and EVT (21% Vs 6%;p<0.001) were significantly higher than in patients with RACE<5.
Conclusion:
This large validation study performed after implementation of the RACE scale in the real clinical practice in the region of Catalonia confirms RACE accuracy to identify candidates to EVT. A RACE score ≥5 detected 77% of patients that finally underwent EVT confirming the scale as a valuable tool at the prehospital level.
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Affiliation(s)
| | - Sonia Abilleira
- Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Marc Ribó
- Hosp Vall d’Hebrón, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Montse Gorchs
- Sistema Emergències Mèdiques Catalunya, Barcelona, Spain
| | | | - Xavier Jiménez
- Sistema Emergències Mèdiques Catalunya, Barcelona, Spain
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10
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Carrera D, Campbell BC, Cortés J, Gorchs M, Querol M, Jiménez X, Millán M, Dávalos A, Pérez de la Ossa N. Predictive Value of Modifications of the Prehospital Rapid Arterial Occlusion Evaluation Scale for Large Vessel Occlusion in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2017; 26:74-77. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/18/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022] Open
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11
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Pérez de la Ossa N, Ribó M, Jiménez X, Abilleira S. Prehospital Scales to Identify Patients With Large Vessel Occlusion. Stroke 2016; 47:2877-2878. [DOI: 10.1161/strokeaha.116.014911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Natalia Pérez de la Ossa
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Marc Ribó
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Xavier Jiménez
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Sònia Abilleira
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
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12
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Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M, Dorado L, López-Cancio E, Hernández-Pérez M, Chicharro V, Escalada X, Jiménez X, Dávalos A. Design and Validation of a Prehospital Stroke Scale to Predict Large Arterial Occlusion. Stroke 2014; 45:87-91. [DOI: 10.1161/strokeaha.113.003071] [Citation(s) in RCA: 299] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We aimed to develop and validate a simple prehospital stroke scale to predict the presence of large vessel occlusion (LVO) in patients with acute stroke.
Methods—
The Rapid Arterial oCclusion Evaluation (RACE) scale was designed based on the National Institutes of Health Stroke Scale (NIHSS) items with a higher predictive value of LVO on a retrospective cohort of 654 patients with acute ischemic stroke: facial palsy (scored 0–2), arm motor function (0–2), leg motor function (0–2), gaze (0–1), and aphasia or agnosia (0–2). Thereafter, the RACE scale was validated prospectively in the field by trained medical emergency technicians in 357 consecutive patients transferred by Emergency Medical Services to our Comprehensive Stroke Center. Neurologists evaluated stroke severity at admission and LVO was diagnosed by transcranial duplex, computed tomography, or MR angiography. Receiver operating curve, sensitivity, specificity, and global accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO.
Results—
In the prospective cohort, the RACE scale showed a strong correlation with NIHSS (
r
=0.76;
P
<0.001). LVO was detected in 76 of 357 patients (21%). Receiver operating curves showed a similar capacity to predict LVO of the RACE scale compared with the NIHSS (area under the curve 0.82 and 0.85, respectively). A RACE scale ≥5 had sensitivity 0.85, specificity 0.68, positive predictive value 0.42, and negative predictive value 0.94 for detecting LVO.
Conclusions—
The RACE scale is a simple tool that can accurately assess stroke severity and identify patients with acute stroke with large artery occlusion at prehospital setting by medical emergency technicians.
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Carmona F, Soto-Ejarque JM, Alonso G, Mora À, Trayner M, Jiménez X. Improvement of myocardinal infarction assistance times when calling an EMS. Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2013.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Rojas S, Herance JR, Gispert JD, Abad S, Torrent E, Jiménez X, Pareto D, Perpiña U, Sarroca S, Rodríguez E, Ortega-Aznar A, Sanfeliu C. In vivo evaluation of amyloid deposition and brain glucose metabolism of 5XFAD mice using positron emission tomography. Neurobiol Aging 2013; 34:1790-8. [PMID: 23402900 DOI: 10.1016/j.neurobiolaging.2012.12.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 12/03/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
Abstract
Positron emission tomography (PET) has been used extensively to evaluate the neuropathology of Alzheimer's disease (AD) in vivo. Radiotracers directed toward the amyloid deposition such as [(18)F]-FDDNP (2-(1-{6-[(2-[F]Fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile) and [(11)C]-PIB (Pittsburg compound B) have shown exceptional value in animal models and AD patients. Previously, the glucose analogue [(18)F]-FDG (2-[(18)F]fluorodeoxyglucose) allowed researchers and clinicians to evaluate the brain glucose consumption and proved its utility for the early diagnosis and the monitoring of the progression of AD. Animal models of AD are based on the transgenic expression of different human mutant genes linked to familial AD. The novel transgenic 5XFAD mouse containing 5 mutated genes in its genome has been proposed as an AD model with rapid and massive cerebral amyloid deposition. PET studies performed with animal-dedicated scanners indicate that PET with amyloid-targeted radiotracers can detect the pathological amyloid deposition in transgenic mice and rats. However, in other studies no differences were found between transgenic mice and their wild type littermates. We sought to investigate in 5XFAD mice if the radiotracers [(11)C]-PIB, and [(18)F]-Florbetapir could quantify the amyloid deposition in vivo and if [(18)F]-FDG could do so with regard to glucose consumption. We found that 5XFAD animals presented higher cerebral binding of [(18)F]-Florbetapir, [(11)C]-PIB, and [(18)F]-FDG. These results support the use of amyloid PET radiotracers for the evaluation of AD animal models. Probably, the increased uptake observed with [(18)F]-FDG is a consequence of glial activation that occurs in 5XFAD mice.
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Affiliation(s)
- Santiago Rojas
- CRC Centre d'Imatge Molecular, CRC Corporació Sanitària, Barcelona, Spain.
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Delgado Hurtado JJ, Jiménez X, Peñalonzo MA, Villatoro C, de Izquierdo S, Cifuentes M. Acceptance of the WHO Surgical Safety Checklist among surgical personnel in hospitals in Guatemala city. BMC Health Serv Res 2012; 12:169. [PMID: 22721269 PMCID: PMC3444374 DOI: 10.1186/1472-6963-12-169] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/11/2012] [Indexed: 11/11/2022] Open
Abstract
Background Studies have highlighted the effects the use of the WHO Surgical Safety Checklist can have on lowering mortality and surgical complications. Implementation of the checklist is not easy and several barriers have been identified. Few studies have addressed personnel’s acceptance and attitudes toward the WHO Surgical Safety Checklist. Determining personnel’s acceptance might reflect their intention to use the checklist while their awareness and knowledge of the checklist might assess the effectiveness of the training process. Methods Through an anonymous self- responded questionnaire, general characteristics of the respondents (age, gender, profession and years spent studying or working at the hospital), knowledge of the WHO Surgical Safety Checklist (awareness of existence, knowledge of objectives, knowledge of correct use), acceptance of the checklist and its implementation (including personal belief of benefits of using the checklist), current use, teamwork and safety climate appreciation were determined. Results Of the 147 surgical personnel who answered the questionnaire, 93.8% were aware of the existence of the WHO Surgical Safety Checklist and 88.8% of them reported knowing its objectives. More nurses than other personnel knew the checklist had to be used before the induction of anesthesia, skin incision, and before the patient leaves the operating room. Most personnel thought using the WHO Surgical Safety Checklist is beneficial and that its implementation was a good decision. Between 73.7% and 100% of nurses in public and private hospitals, respectively, reported the checklist had been used either always or almost always in the general elective surgeries they had participated in during the current year. Conclusions Despite high acceptance of the checklist among personnel, gaps in knowledge about when the checklist should be used still exist. This can jeopardize effective implementation and correct use of the checklist in hospitals in Guatemala City. Efforts should aim to universal awareness and complete knowledge on why and how the checklist should be used.
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Igual L, Soliva JC, Hernández-Vela A, Escalera S, Jiménez X, Vilarroya O, Radeva P. A fully-automatic caudate nucleus segmentation of brain MRI: application in volumetric analysis of pediatric attention-deficit/hyperactivity disorder. Biomed Eng Online 2011; 10:105. [PMID: 22141926 PMCID: PMC3252254 DOI: 10.1186/1475-925x-10-105] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/05/2011] [Indexed: 11/21/2022] Open
Abstract
Background Accurate automatic segmentation of the caudate nucleus in magnetic resonance images (MRI) of the brain is of great interest in the analysis of developmental disorders. Segmentation methods based on a single atlas or on multiple atlases have been shown to suitably localize caudate structure. However, the atlas prior information may not represent the structure of interest correctly. It may therefore be useful to introduce a more flexible technique for accurate segmentations. Method We present Cau-dateCut: a new fully-automatic method of segmenting the caudate nucleus in MRI. CaudateCut combines an atlas-based segmentation strategy with the Graph Cut energy-minimization framework. We adapt the Graph Cut model to make it suitable for segmenting small, low-contrast structures, such as the caudate nucleus, by defining new energy function data and boundary potentials. In particular, we exploit information concerning the intensity and geometry, and we add supervised energies based on contextual brain structures. Furthermore, we reinforce boundary detection using a new multi-scale edgeness measure. Results We apply the novel CaudateCut method to the segmentation of the caudate nucleus to a new set of 39 pediatric attention-deficit/hyperactivity disorder (ADHD) patients and 40 control children, as well as to a public database of 18 subjects. We evaluate the quality of the segmentation using several volumetric and voxel by voxel measures. Our results show improved performance in terms of segmentation compared to state-of-the-art approaches, obtaining a mean overlap of 80.75%. Moreover, we present a quantitative volumetric analysis of caudate abnormalities in pediatric ADHD, the results of which show strong correlation with expert manual analysis. Conclusion CaudateCut generates segmentation results that are comparable to gold-standard segmentations and which are reliable in the analysis of differentiating neuroanatomical abnormalities between healthy controls and pediatric ADHD.
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Affiliation(s)
- Laura Igual
- Department of Applied Mathematics and Analysis, University of Barcelona (UB), Gran Via de les Corts Catalanes 585, Barcelona 08007, Spain.
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Herance R, Rojas S, Abad S, Jiménez X, Gispert JD, Millán O, Martín-García E, Burokas A, Serra MÀ, Maldonado R, Pareto D. Positron emission tomographic imaging of the cannabinoid type 1 receptor system with [¹¹C]OMAR ([¹¹C]JHU75528): improvements in image quantification using wild-type and knockout mice. Mol Imaging 2011; 10:481-487. [PMID: 22201539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
In this study, we assessed the feasibility of using positron emission tomography (PET) and the tracer [¹¹C]OMAR ([¹¹C]JHU75528), an analogue of rimonabant, to study the brain cannabinoid type 1 (CB1) receptor system. Wild-type (WT) and CB1 knockout (KO) animals were imaged at baseline and after pretreatment with blocking doses of rimonabant. Brain uptake in WT animals was higher (50%) than in KO animals in baseline conditions. After pretreatment with rimonabant, WT uptake lowered to the level of KO animals. The results of this study support the feasibility of using PET with the radiotracer [¹¹C]JHU75528 to image the brain CB1 receptor system in mice. In addition, this methodology can be used to assess the effect of new drugs in preclinical studies using genetically manipulated animals.
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Affiliation(s)
- Raúl Herance
- Institut d’Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain
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Hoekzema E, Rojas S, Herance R, Pareto D, Abad S, Jiménez X, Figueiras FP, Popota F, Ruiz A, Flotats N, Fernández FJ, Rocha M, Rovira M, Víctor VM, Gispert JD. [11C]-DASB microPET imaging in the aged rat: Frontal and meso-thalamic increases in serotonin transporter binding. Exp Gerontol 2011; 46:1020-5. [DOI: 10.1016/j.exger.2011.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/15/2011] [Accepted: 09/21/2011] [Indexed: 10/17/2022]
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Herance R, Rojas S, Abad S, Jiménez X, Gispert JD, Millán O, Martín-García E, Burokas A, Serra MÀ, Maldonado R, Pareto D. Positron Emission Tomographic Imaging of the Cannabinoid Type 1 Receptor System with [11C]OMAR ([11C]JHU75528): Improvements in Image Quantification Using Wild-Type and Knockout Mice. Mol Imaging 2011. [DOI: 10.2310/7290.2011.00019s] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Raúl Herance
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Santiago Rojas
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Sergio Abad
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Xavier Jiménez
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Juan Domingo Gispert
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Olga Millán
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Elena Martín-García
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Aurelijus Burokas
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Miquel Àngel Serra
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Rafael Maldonado
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Deborah Pareto
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporació Sanitària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neurophar-macology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
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Herance R, Rojas S, Abad S, Jiménez X, Gispert JD, Millán O, Martín-García E, Burokas A, Serra MÀ, Maldonado R, Pareto D. Positron Emission Tomographic Imaging of the Cannabinoid Type 1 Receptor System with [11C]OMAR ([11C]JHU75528): Improvements in Image Quantification Using Wild-Type and Knockout Mice. Mol Imaging 2011. [DOI: 10.2310/7290.2011.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this study, we assessed the feasibility of using positron emission tomography (PET) and the tracer [11C]OMAR ([11C]JHU75528), an analogue of rimonabant, to study the brain cannabinoid type 1 (CB1) receptor system. Wild-type (WT) andCB1 knockout (KO) animals were imaged at baseline and after pretreatment with blocking doses of rimonabant. Brain uptake in WT animals was higher (50%) than in KO animals in baseline conditions. After pretreatment with rimonabant, WT uptake lowered to the level of KO animals. The results of this study support the feasibility of using PET with the radiotracer [11C]JHU75528 to image the brain CB1 receptor system in mice. In addition, this methodology can be used to assess the effect of new drugs in preclinical studies using genetically manipulated animals.
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Affiliation(s)
- Raúl Herance
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Santiago Rojas
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Sergio Abad
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Xavier Jiménez
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Juan Domingo Gispert
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Olga Millán
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Elena Martín-García
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Aurelijus Burokas
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Miquel Àngel Serra
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Rafael Maldonado
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
| | - Deborah Pareto
- From the Institut d'Alta Tecnologia, Parc de Recerca Biomèdica de Barcelona, CRC Corporació Sanitaària, Barcelona, Spain; Centro Imagen Molecular, CRC Corporacioó Sanitaària, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain; and Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Universitat Pompeu Fabra–PRBB, Barcelona, Spain
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Hoekzema E, Herance R, Rojas S, Pareto D, Abad S, Jiménez X, Figueiras FP, Popota F, Ruiz A, Torrent È, Fernández-Soriano FJ, Rocha M, Rovira M, Víctor VM, Gispert JD. The effects of aging on dopaminergic neurotransmission: a microPET study of [11C]-raclopride binding in the aged rodent brain. Neuroscience 2010; 171:1283-6. [PMID: 20937365 DOI: 10.1016/j.neuroscience.2010.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 09/29/2010] [Accepted: 10/03/2010] [Indexed: 10/19/2022]
Abstract
Rodent models are frequently used in aging research to investigate biochemical age effects and aid in the development of therapies for pathological and non-pathological age-related degenerative processes. In order to validate the use of animal models in aging research and pave the way for longitudinal intervention-based animal studies, the consistency of cerebral aging processes across species needs to be evaluated. The dopaminergic system seems particularly susceptible to the aging process, and one of the most consistent findings in human brain aging research is a decline in striatal D2-like receptor (D2R) availability, quantifiable by positron emission tomography (PET) imaging. In this study, we aimed to assess whether similar age effects can be discerned in rat brains, using in vivo molecular imaging with the radioactive compound [(11)C]-raclopride. We observed a robust decline in striatal [(11)C]-raclopride uptake in the aged rats in comparison to the young control group, comprising a 41% decrement in striatal binding potential. In accordance with human studies, these results indicate that substantial reductions in D2R availability can be measured in the aged striatal complex. Our findings suggest that rat and human brains exhibit similar biochemical alterations with age in the striatal dopaminergic system, providing support for the pertinence of rodent models in aging research.
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Affiliation(s)
- E Hoekzema
- Department de Psiquiatria i Medicina Legal, Universitat Autônoma de Barcelona, 08192, Bellaterra, Barcelona, Spain
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Rojas S, Herance JR, Abad S, Jiménez X, Pareto D, Ruiz A, Torrent È, Figueiras FP, Popota F, Fernández-Soriano FJ, Planas AM, Gispert JD. Evaluation of Hypoxic Tissue Dynamics with 18F-FMISO PET in a Rat Model of Permanent Cerebral Ischemia. Mol Imaging Biol 2010; 13:558-564. [DOI: 10.1007/s11307-010-0371-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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