John Adam Oostema

Michigan State University | MSU · Department of Emergency Medicine

Background: Large vessel occlusion (LVO) stroke patients are often transferred from regional hospitals to comprehensive stroke centers (CSC) for thrombectomy. The need for repeat imaging at CSCs prior to intervention is unclear. We compared regional hospital and CSC perfusion imaging results for interfacility transfers in a single health system. Me...

Introduction: In recent years, Medicare Advantage (MA) enrollment in the US has increased dramatically relative to traditional Medicare (TM). There is evidence to suggest that MA stroke patients are less likely to receive inpatient rehabilitation facility (IRF) based care in favor of home health. To evaluate potential gaps in quality of care, we co...

Background: Despite substantial to minimize ischemic stroke treatment delays, hospital door-to-needle (DTN) time variations persist. We sought to identify sources of variation in practice as well as understand stroke team member perceptions of factors that influence DTN performance in a sample of hospitals that participate in a statewide stroke reg...

Introduction: Hospital readmissions are often used as an indicator of quality of care. However, identifying patients at risk of readmission after stroke is challenging and predictive models have historically not performed well, in part because they often rely on single data sources. Data linkage might offer a solution. Methods: We probabilistically...

Intro: The Michigan Stroke Program (MiSP) monitors statewide EMS stroke care performance and data quality. Starting in 2018, quarterly performance and outcome benchmark data were shared with EMS agency partners to support prehospital quality improvement (QI) for stroke patients. Objective: To improve EMS data quality and prehospital stroke care per...

BACKGROUND Emergency medical services (EMS) is an important link in the stroke chain of recovery. Various prehospital quality metrics have been proposed for prehospital stroke care, but their individual impact is uncertain. We sought to measure associations between EMS quality metrics and downstream stroke care. METHODS This is a retrospective ana...

Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage, emergency departments lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) appro...

The prehospital phase is a critical component of delivering high-quality acute stroke care. This topical review discusses the current state of prehospital acute stroke screening and transport, as well as new and emerging advances in prehospital diagnosis and treatment of acute stroke. Topics include prehospital stroke screening, stroke severity scr...

Background and Purpose: Tenecteplase (TNK) has recently been demonstrated to be an effective thrombolytic agent in patients with acute ischemic stroke. Our 9-hospital stroke network transitioned to tenecteplase as the standard stroke thrombolytic in April 2022. We assessed the impact of TNK use in routine clinical practice on quality metrics and ou...

Background: Mechanical thrombectomy (MT) is effective for reducing morbidity in patients presenting within 24 hours of symptom onset with large vessel occlusion (LVO). Perfusion imaging is helpful in selecting patients in this extended time window. We report our experience of implementing CTP imaging in all our spokes and its impact on quality metr...

Study Objective: Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage (ICH), Emergency Departments (EDs) lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rathe...

Background: Perfusion imaging is used to determine eligibility for mechanical thrombectomy (MT) in patients presenting with large vessel occlusion (LVO) in acute ischemic stroke. The utility of CT perfusion (CTP) imaging in spoke hospitals remains controversial. The aim of the study was to compare the imaging parameters, functional and safety outco...

Background Emergency medical services (EMS) compliance with recommended prehospital care for patients with acute stroke is inconsistent; however, sources of variability in compliance are not well understood. The current analysis utilizes a linkage between a statewide stroke registry and EMS information system data to explore patient and EMS agency‐...

Objectives: Most acute stroke research is conducted at academic and larger hospitals, which may differ from many non-academic (ie, community) and smaller hospitals with respect to resources and consultant availability. We describe current emergency department (ED) and hospital-level stroke-related capabilities among a sample of community EDs parti...

Background Termination of a clinical trial before the maximum planned sample size is accrued can occur for multiple valid reasons but has implications for the interpretation of results. We undertook a systematic review of contemporary acute stroke trials to document the prevalence of and reasons for early termination. Methods We searched MEDLINE f...

This cross-sectional study compares trends in out-of-hospital cardiac arrests and fatalities in the Detroit area during the COVID-19 pandemic with year-earlier events for the same period.

Background: Hemorrhagic stroke is a medical emergency that requires rapid identification and treatment. Despite playing a critical role in the emergency response to hemorrhagic stroke patients, a minimal amount is known about the quality of emergency medical services (EMS) care for this condition. The objectives of this study were to quantify EMS...

Background Understanding and improving EMS stroke care requires linking data from both the prehospital and hospital settings. In the US, such data is collected in separate de-identified registries that cannot be directly linked due to lack of a common, unique patient identifier. In the absence of unique patient identifiers two common approaches to...

Purpose This review summarizes the current science underpinning the treatment of patients with ischemic stroke who awaken with stroke symptoms. This large subset of stroke patients has historically been precluded from treatment with disability-limiting reperfusion therapies such as intravenous thrombolysis. Recent advances in neuroimaging have shif...

Background: Endovascular therapy (EVT) offers dramatic benefit to selected patients with large vessel occlusion (LVO) ischemic stroke. However, identification of EVT candidates requires advanced imaging and often interfacility transfer. We sought to quantify the yield of such testing as well as identify clinical predictors of EVT candidacy. Methods...

Introduction: A priori sample size determination is an essential step in designing randomized controlled trials (RCTs). Failure to reach pre-planned sample size introduces risk of both falsely negative and spuriously positive findings. We undertook a systematic review of contemporary acute stroke trials to document the prevalence and reasons for te...

Objectives: Endovascular therapy (EVT) improves outcomes for appropriately selected acute ischemic stroke patients. Guidelines suggest rapid acquisition of noninvasive vascular imaging to screen suspected ischemic stroke patients for large vessel occlusion (LVO) and candidacy for EVT. We sought to quantify the yield of an LVO stroke screening proc...

Background and Purpose— Emergency medical services (EMS) stroke recognition facilitates rapid care, however, prehospital stroke screening tools rely on signs that are often absent in posterior circulation strokes. We hypothesized that addition of the finger-to-nose (FTN) test to the Cincinnati Prehospital Stroke Scale would improve EMS posterior st...

Background and Purpose— Recognition of stroke symptoms and hospital prenotification by emergency medical services (EMS) facilitate rapid stroke treatment; however, one-third of patients with stroke are unrecognized by EMS. To promote stroke recognition and quality measure compliant prehospital stroke care, we deployed a 30-minute online EMS educati...

Background: Emergency Medical Services (EMS) transport facilitates rapid ischemic stroke treatment. We hypothesized that EMS stroke recognition is critical to delivery of optimal stroke care and favorably impacts downstream outcomes. Methods: We identified consecutive EMS-transported ischemic stroke (IS) and transient ischemic attack (TIA) patients...

Background: Michigan’s Ongoing Stroke Registry to Accelerate Improvement of Care (MOSAIC) supports expansion of statewide stroke systems of care. The Michigan EMS Information System (Mi-EMSIS) is a repository for EMS data developed to standardize collection, storage, sharing and analysis of data. To provide feedback to EMS providers concerning stro...

The window for acute ischemic stroke treatment was previously limited to 4.5 hours for intravenous tissue plasminogen activator and to 6 hours for thrombectomy. Recent studies using advanced imaging selection expand this window for select patients up to 24 hours from last known well. These studies directly affect emergency stroke management, includ...

Background Following the results of randomized clinical trials supporting the use of mechanical thrombectomy (MT) with tissue plasminogen activator for emergent large vessel occlusion (ELVO), our state Stroke Task Force convened to: update legislation to recognize differences between Primary Stroke Centers (PSCs) and Comprehensive Stroke Centers (C...

A short cut review was carried out to establish the rate and clinical characteristics of missed diagnosis of acute ischaemic stroke in the emergency department (ED). Two papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and s...

BACKGROUND: Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combin...

Background: Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke cod...

Background: Emergency medical services (EMS) stroke recognition is critical for appropriate triage and rapid activation of stroke systems. Posterior strokes represent up to 25% of acute stroke admissions. Prehospital stroke screening tools such as the Cincinnati Prehospital Stroke Scale (CPSS) rely on stroke signs that may not be present in patient...

Introduction: Neurology led Stroke Teams are becoming imperative in recent care models of acute stroke management. Advanced Practice Providers (APP) are important members of these stroke teams. Code Stroke simulations allow (APP) to gain valuable experience in the evaluation and treatment of a potential stroke patient without compromising patient c...

Background: EMS stroke recognition and hospital prenotification facilitate rapid stroke treatment. However, EMS stroke recognition is suboptimal. To promote stroke recognition, we deployed a 30-minute online EMS educational module in a single southwestern Michigan county. Methods: Following 12 months of baseline data collection, the online module w...

Objective: As the first point of contact for patients activating emergency medical services (EMS), emergency dispatchers have the earliest opportunity to recognize stroke. We sought to quantify dispatcher stroke recognition and its relationships with EMS stroke recognition and response speed. Methods: We assembled a cohort of consecutive EMS-tra...

Introduction: Utilization of EMS is associated with faster emergency department evaluation and treatment of patients with stroke, especially among EMS-recognized patients. However, most research focuses on patients with ischemic stroke. We sought to identify factors associated with prehospital recognition of hemorrhagic stroke and the impact of rec...

Introduction: Emergency Medical Services (EMS) are an important component of stroke systems of care. EMS transport has been associated with faster emergency department (ED) stroke evaluations and higher t-PA delivery rates, especially among EMS recognized cases with hospital prenotification. However, delivery of high quality care including hospital...

Background: Acute ischemic stroke patients that are recognized by Emergency medical services (EMS) receive expedited care are more likely to receive t-PA. In order to study the continuum of acute stroke care and ensure accurate case ascertainment, prehospital and inpatient medical records must be linked. We tested the feasibility of probabilistic m...

A short cut review was carried out to see if tadalafil, a phosphodiesterase type-5 (PDE5) inhibitor, was superior to standard α-adrenergic antagonists at promoting spontaneous ureteric calculi excretion. Two relevant papers were found, published by the same research group. The author, date and country of publication, patient group studied, study ty...

Background: Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Preho...

Background: Patients are at high risk for stroke following a transient ischemic attack (TIA). The ideal setting for evaluating and treating patients with TIA has not been established, resulting in variability in emergency department (ED) TIA management. We conducted a survey to describe ED TIA management and factors that influence disposition dete...

Introduction: Ischemic stroke patients who arrive by emergency medical service (EMS) receive faster emergency department evaluations and improved rates of thrombolytic treatment. However, EMS stroke recognition and compliance with prehospital stroke quality measures are inconsistent. We hypothesized that EMS stroke care is influenced by a complex i...

Introduction: Emergency dispatchers are usually the first contact point for stroke patients accessing the healthcare system. Dispatcher stroke recognition is associated with better paramedic stroke recognition and faster emergency medical services (EMS) response time, but stroke is often unrecognized during the initial call. We conducted a systemat...

Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification. Using EMS and hospital records, we assembled a cohort of EMS-transporte...

Introduction: The diagnosis of TIA is often challenging in the emergency department (ED) setting. ICD-9 discharge code 435 is often used to identify TIA cases; however, its accuracy is unclear. Our objective was to determine the sensitivity of ICD-9 code 435 to identify confirmed TIA cases treated in 4 community-based EDs. Methods: Over a 12 month...

Background: Prehospital activation of in-hospital stroke response depends on accurate Emergency Medical Services (EMS) provider stroke recognition. While screening tools such as the Cincinnati Prehospital Stroke Scale (CPSS) have been validated, their real world impact is less clear. We determined the accuracy of prehospital stroke recognition and...

Introduction: Patients who present to the Emergency department (ED) with transient ischemic attack (TIA) receive a wide variety of imaging tests. We describe the use, yield, and prognostic implications of diagnostic imaging undertaken in a cohort of TIA patients. Methods: Patients with a high clinical suspicion of TIA were prospectively identified...

Background: Prehospital activation of in-hospital stroke response depends on accurate Emergency Medical Services (EMS) provider stroke recognition. While screening tools such as the Cincinnati Prehospital Stroke Scale (CPSS) have been validated, their real world impact is less clear. We determined the accuracy of prehospital stroke recognition and...

Background: A number of emergency medical services (EMSs) performance measures for stroke have been proposed to promote early stroke recognition and rapid transportation to definitive care. This study examined performance measure compliance among EMS-transported stroke patients and the relationship between compliance and in-hospital stroke respons...

National guidelines advocate for early, aggressive transient ischemic attack (TIA) evaluations and recommend diffusion-weighted magnetic resonance imaging (MRI) for brain imaging. The purpose of this study is to examine clinician compliance, the yield of MRI, and patient-centered clinical outcomes following implementation of an emergency department...

Introduction: The diagnosis of TIA is often challenging in the emergency department (ED) setting. ICD-9 discharge code 435 is often used to identify TIA cases; however, its accuracy is unclear. Our objective was to determine the sensitivity of ICD-9 code 435 to identify confirmed TIA cases treated in 4 community-based EDs. Methods: Over a 12 month...

Introduction: Patients who present to the Emergency department (ED) with transient ischemic attack (TIA) receive a wide variety of imaging tests. We describe the use, yield, and prognostic implications of diagnostic imaging undertaken in a cohort of TIA patients. Methods: Patients with a high clinical suspicion of TIA were prospectively identified...

Background: Evaluation of prehospital stroke care quality has been limited by the inability to link EMS and hospital data. The Prehospital Acute Stroke Surveillance System (PASSS) is designed to assess prehospital stroke care in Kent Country, Michigan through linkage of EMS and hospital data for patients transported with suspected or confirmed stro...

Study objective: The optimal diagnostic evaluation for establishing the risk of stroke among patients presenting to the emergency department (ED) with a transient ischemic attack has not been determined. The objective of this review is to assess the ability of diffusion-weighted magnetic resonance imaging (MRI) to predict the short-term risk of st...

DATA SOURCES: The authors searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Wounds Group Specialized Register (May 29, 2008), MEDLINE (1950 to May 2008), EMBASE (1980 to May 2008), and CINAHL (1982 to May 2008). STUDY SELECTION: The review included randomized controlled trials examining various burn dressings, f...

Computer-based, virtual-reality laparoscopic surgical simulators have several advantages over traditional video trainers. One of these advantages is that performance can be evaluated using unique computer-derived metrics, which can be digitally archived for analysis at a time convenient to instructors. This study sought to determine whether the com...