Paramedic PapersHome Stroke & neuro Ultrasound added to stroke scales for LVO triage
Stroke & neuro
Ultrasound added to stroke scales for LVO triage
Added value of brain perfusion ultrasound to prehospital stroke scales-a secondary analysis of the SONAS trial
Frontiers in Neurology · 2026-10-23 · Added 9 November 2026
A German exploratory reanalysis of the 20-patient SONAS trial found portable non-imaging brain perfusion ultrasound combined with prehospital stroke scales sorted suspected stroke into likely-LVO, likely-non-LVO and unassessable groups better than either method alone.
- Study type
- Other
- Design
- Exploratory secondary analysis of a 20-patient portable ultrasound device trial
- Participants
- 20 patients with acute ischaemic stroke
- Main finding
- Combining brain perfusion ultrasound with prehospital stroke scales shifted sensitivity and negative predictive value higher and reclassified all patients misdiagnosed by either method alone; three prehospital-ICH false positives showed severe perfusion deficits suggesting LVO
- Caveat
- Only 20 patients, retrospective design, and the authors themselves call validation critical
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). Portable ultrasound is carried by a handful of Australian services, most don't, and prehospital LVO triage is an active question here — the approach informs that debate rather than current practice.
Learning goal
Weigh the value of portable brain perfusion ultrasound in improving prehospital triage of suspected large vessel occlusion stroke.
More
- Topic: Stroke & neuro
- Daily scan: 9 November 2026
- Podcast: Paramedic Papers Daily, 9 November 2026
Related papers on Stroke & neuro
-
Stroke triage app adopted but not embedded
A Dutch mixed-methods evaluation of the Stroke Triage App across two EMS regions found good initial adoption (median 120 app triages/month) but inconsistent routine integration, with workflow fit and limited perceived added value the main barriers.
-
M-DIRECT stroke triage scale revalidated
A Spanish prospective study of 1,950 prehospital code-stroke patients revalidated the M-DIRECT scale five years after implementation, showing 77% sensitivity and 76% specificity for identifying endovascular-treatment candidates, with a positive score more than tripling the odds of EVT.
-
Prehospital stroke triage: high under- and overtriage rates
A Swiss single-centre quality-control study of a prehospital stroke triage pathway found EMS undertriaged 21% and overtriaged 63% of acute reperfusion candidates, with both rates falling when a coordinated medical team (including a neurologist) was phone-consulted.
-
CT stroke unit model separates diagnosis from transport
Japanese authors describe a conceptual EMS-integrated diagnostic-focused mobile stroke unit model that keeps CT diagnosis at the scene or rendezvous point but hands treatment and transport to existing EMS vehicles, aiming to cut cost, staffing and operational complexity.