STRAUMA activation: Evaluation of stroke and trauma simultaneously

Ananya Ghosal, MAKAUT(WB)

STRAUMA is an advanced hospital vigilance that permits the patient having stroke symptoms to diagnose rapidly for traumatic injuries without holding up the time for life-saving treatment and imaging of the brain. Mostly the major cause of death in the US is stroke. The common symptoms of a stroke are-

• Sudden confusion
• Balance loss and dizziness
• One side of the body feels week
• Trouble in vision

Tissue Plasminogen Activator(tPA) is an intervening drug that helps in dissolving the clot, where the clot results in ischemic stroke. The drug might be harmful to the patient bleeding due to serious injury. Janet Lee stated that “The novel STRAUMA activation permits accelerating the diagnosis of both stroke and trauma for smooth administration of life-saving interference. Severe injuries like intracranial hemorrhage, head trauma, or bleeding that would result in catastrophic bleeding should be ruled out before providing tPA for the treatment of stroke.

Major findings of the study:

A dual alert protocol for both stroke and trauma was introduced by the researchers at UC Health Memorial hospital in 2018. To recognize a traumatic injury by the rules of STRAUMA activation that permits the trauma team and emergency department team to retrieve the patient with the symptoms of stroke and trauma first. If the injury is not serious then the patient should be immediately forwarded to Computed Tomography (CT) scanning that confirms the stroke-like hemorrhagic or ischemic that occurred due to blood vessel rupture.

According to the study, researchers tried to find out the effect of STRAUMA activation, which put on an additional procedure to the diagnosis whether affects the time-to-tPA and time-to-CT application. In between January 2019 and September 2020, 580 adult men and women were recorded who had either STRAUMA activation or stroke alert within 15 minutes of coming to the level I trauma and comprehensive stroke center. Among them, 469 patients had activated stroke alert and 111 had STRAUMA activation.

• The stroke alert group has fewer neurological problems than the STRAUMA group. Based on the NIH stroke scale, the STRAUMA score median of 11 whereas the stroke alert group has scored a median of 5. The score over the median of 16 indicates death.
• The STRAUMA activation group has a longer time-to-CT than the stroke alert group.
• The stroke alert group has a higher rate of tPA application than the STRAUMA group as the stroke alert group has 27.9% tPA application and the STRAUMA group has 13.5% tPA application as there were few stroke diagnoses in the STRAUMA group.
• It was found that the rate of thrombectomy was nearly equal between the stroke alert group and the STRAUMA group.
• The time-to-tPA is also nearly equal between the stroke alert group and the STRAUMA group.
• The severe trauma group is described as an Injury Severity Score (ISS) of 15 or more. The general percentage of STRAUMA patients experiencing traumatic injury was 15% which gives an ISS score of 9.
• The stroke alert group has a 6% mortality rate whereas the STRAUMA group has a 14.4% mortality rate that giving rise to the stroke alert group having a lower mortality rate than the STRAUMA group.
• The STRAUMA activation has not affected the mortality risk whereas, the time-to-CT and NIH stroke scales are the key points to predict mortality.

Conclusion:

As stated by Dr. Lee “stroke alert group has shorter time-to-CT as the strauma activation has put on six minutes to the entire process. The risk of delaying CT-scanning lesser the risk of having catastrophic bleeding and administering tPA. Nearly 80 STRAUMA activation arrives in UC health trauma center each year.

Also read: A scaffold-free method: Harnessing stem cells to create Cartilage tissues!

Reference:

1. Lee, J. S., Finch, H., Higa, K., Khan, A. D., Brockman, V., & Schroeppel, T. J. (2021). Strauma alert: A novel alert system for a combined stroke and trauma. Journal of the American College of Surgeons, 233(5), S303–S304. https://doi.org/10.1016/j.jamcollsurg.2021.07.628

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