{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:25:41Z","timestamp":1760145941103,"version":"build-2065373602"},"reference-count":68,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T00:00:00Z","timestamp":1725408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Prehospital detection and triage of stroke patients mostly rely on the use of large vessel occlusion prediction scales to decrease onsite time. These quick but simplified scores, though useful, prevent prehospital providers from detecting posterior strokes and isolated symptoms such as limb ataxia or hemianopia. Case report: In the present case, an ambulance was dispatched to a 46-year-old man known for ophthalmic migraines and high blood pressure, who presented isolated visual symptoms different from those associated with his usual migraine attacks. Although the assessment advocated by the prehospital guideline was negative for stroke, the paramedic who assessed the patient was one of the few trained in the National Institutes of Health Stroke Scale assessment. Based on this assessment, the paramedic activated the fast-track stroke alarm and an ischemic stroke in the right temporal lobe was finally confirmed by magnetic resonance imaging. Discussion and conclusions: Current prehospital practice enables paramedics to detect anterior strokes but often limits the detection of posterior events or more subtle symptoms. Failure to identify such strokes delay or even forestall the initiation of thrombolytic therapy, thereby worsening patient outcomes. We therefore advocate a two-step prehospital approach: first, to avoid unnecessary delays, the prehospital stroke assessment should be carried out using a fast large vessel occlusion prediction scale; then, if this assessment is negative but potential stroke symptoms are present, a full National Institutes of Health Stroke Scale assessment could be performed to detect neurological deficits overlooked by the fast stroke scale.<\/jats:p>","DOI":"10.3390\/jcm13175233","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T04:28:28Z","timestamp":1725424108000},"page":"5233","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Two-Step Approach Using the National Health Institutes of Health Stroke Scale Assessed by Paramedics to Enhance Prehospital Stroke Detection: A Case Report and Concept Proposal"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1663-5249","authenticated-orcid":false,"given":"Loric","family":"Stuby","sequence":"first","affiliation":[{"name":"Gen\u00e8ve TEAM Ambulances, Emergency Medical Services, 1201 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e9lanie","family":"Suppan","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thibaut","family":"Desmettre","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Carrera","sequence":"additional","affiliation":[{"name":"Stroke Center, Department of Neurology, Geneva University Hospitals and Faculty of Medicine, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1945-8318","authenticated-orcid":false,"given":"Matthieu","family":"Genoud","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-6421","authenticated-orcid":false,"given":"Laurent","family":"Suppan","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1161\/STROKEAHA.123.043846","article-title":"Emergency Medical Services Compliance with Prehospital Stroke Quality Metrics Is Associated with Faster Stroke Evaluation and Treatment","volume":"55","author":"Oostema","year":"2024","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2480","DOI":"10.1001\/jama.2013.6959","article-title":"Time to Treatment with Intravenous Tissue Plasminogen Activator and Outcome from Acute Ischemic Stroke","volume":"309","author":"Saver","year":"2013","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s11883-018-0734-x","article-title":"Prehospital Prediction of Large Vessel Occlusion in Suspected Stroke Patients","volume":"20","author":"Keenan","year":"2018","journal-title":"Curr. 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