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Aim  To establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city‐wide transportation system using the Maria Prehospital Stroke Scale ( MPSS ), a novel prehospital stroke scale for emergency medical technicians ( EMT s) to predict the likelihood of thrombolytic therapy after transportation.    Methods  Kawasaki City, Japan, has six comprehensive stroke centers ( CSC s) and six primary stroke centers ( PSC s). In  CSC s, endovascular therapy can be carried out 24 h a day, 7 days a week, but not in  PSC s. There is no “drip and ship” protocol for further endovascular therapy from  PSC s to  CSC s. We determined the predictive value of  MPSS  scoring by the  EMT s for the performance of endovascular therapy after transportation.    Results  There were 2031 patients (mean age, 71.1 ± 13.3 years) registered from April 2012 to March 2015. Multivariate logistic regression analysis indicated that the  MPSS  score and type of stroke center were independent predictors for performance of endovascular therapy. In particular, the odds ratio ( OR ) for endovascular therapy was significant for  MPSS  score 3 ( OR , 2.914; 95% confidence interval ( CI ), 1.152–7.372;  P  = 0.024),  MPSS  score 4 ( OR , 5.474; 95% CI , 2.300–13.029;  P  = 0.000), and  MPSS  score 5 ( OR , 11.459; 95% CI , 4.334–30.296;  P  = 0.000) when  MPSS  score 1 was set as a reference. The diagnostic accuracy of the  MPSS  score evaluated by  EMT s was 0.689 (95% CI , 0.627–0.751).    Conclusions  Prehospital triage using  MPSS  scores evaluated by  EMT s can predict the likelihood of performance of endovascular therapy after transportation, and may become a tool offering a flexible solution for designing a new transportation protocol.

Prehospital triage for endovascular clot removal in acute stroke patients