Background:Little is known about how prehospital triage using large vessel occlusion
(LVO) stroke prediction scales affects patients with intracerebral
hemorrhage (ICH).Objectives:We aimed to investigate whether the Stockholm Stroke Triage System (SSTS)
implemented in 2017 has affected timing and outcomes of acute ICH
neurosurgery, and to assess system triage accuracy for ICH with a
neurosurgical indication or LVO thrombectomy.Design:Observational cohort study.Methods:In the Stockholm Region, we compared surgical timing, functional outcome, and
death at 3 months in patients transported by code-stroke ground ambulance
who had ICH neurosurgery, 2 years beforeversus2 years
after SSTS implementation. We also calculated triage precision metrics for
treatment with either ICH neurosurgery or thrombectomy.Results:A total of 36 patients undergoing ICH neurosurgery were included before SSTS
implementation and 30 after. No significant difference was found in timing
of neurosurgery [median 7.5 (4.9–20.7)versus9.1
(6.1–12.5) h after onset], distribution of functional outcomes (median 4versus4), and death at 3 months [3/29 (9%)versus5/35 (17%)] beforeversusafter
implementation, respectively. The SSTS routed a larger proportion of
patients subsequently undergoing ICH neurosurgery directly to the
comprehensive stroke center: 13/36 (36%) beforeversus18/30 (60%) after implementation. Overall system triage accuracy for ICH
neurosurgery or thrombectomy was high at 90%, with 92% specificity and 65%
sensitivity.Conclusion:The SSTS, initially designed for prehospital LVO stroke triage, routed more
patients with neurosurgical indication for ICH directly to the comprehensive
stroke center. This did not significantly affect surgical timing or
outcomes.