WP2 – Pre-hospital stroke triage (PRESTIGE)

WP leaders

Jonathan Coutinho (AUMC) & Bob Roozenbeek (EMC)

The workpackage

The general hypothesis of the PRESTIGE WP is that optimizing the pre-hospital workflow of stroke patients by implementing a technological solution for triage of LVOstroke patients will shorten time-to-treatment and improve the clinical outcome of patients.

Currently, ambulance paramedics cannot effectively diagnose acute stroke in the field, let alone differentiate between large vessel occlusion (LVO), non-LVO strokes, and intracerebral hemorrhage. Thus, paramedics bring a patient with a suspected stroke to the nearest IVT-capable hospital, which is for most patients a primary stroke center (PSC). If an LVO stroke is diagnosed at the PSC, the patient needs to be rushed a second time by ambulance paramedics to the nearest comprehensive stroke center (CSC) to undergo EVT. This type of pre-hospital workflow is employed almost everywhere in the world. Even in the Netherlands, where distances between hospitals are short, this ‘drip-and-ship’ paradigm results in an average treatment delay of approximately one hour for each patient who is initially presented to a PSC and who requires EVT, resulting in an absolute decrease in the chance of a good clinical outcome up to 10% (5-7). Hence, treating LVO stroke more effectively demands improved pre-hospital workflow processes. Ideally, paramedics would be able to identify stroke patients requiring EVT in the ambulance, so that they can specifically transport these patients – and only these patients – to the nearest CSC.


The PRESTIGE WP is divided into two sequential parts: A and B.

Part A
The main objective of Part A is to provide “testing grounds” in which various technological solutions for pre-hospital stroke triage are analyzed in detail at a regional level, determining their suitability for use in routine clinical practice. Suitability of each solution will be determined according to previously published requirements. Part A will run from M1-M24. The projects included in Part A are mainly funded from resources other than the IMPULSE Program. Bringing these projects under the umbrella of this WP enables us to harmonize studies in terms of data collection and outcome definitions. This will facilitate their comparability and will increase the possibilities for re-use of data. The “testing grounds” focus on: 1) Electroencephalography (objective A1); 2) Stroke Triage App (objective A2) Bloodbased biomarker profiles (objective A3); Transcranial Doppler (objective A4). During Part A, additional regional projects aiming to evaluate other promising technological solutions for pre-hospital stroke triage can join this WP to serve as additional “testing grounds” as soon as funding (from other resources) is secured.

Part B
The objective of Part B is to perform a phase 3 implementation study at the national level, investigating the most promising technical solution(s) for pre-hospital stroke triage from Part A. Part B will run from M25-M60.