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Analysis of institutional authors

Fuentes, BlancaCorresponding AuthorAlonso De Lecinana, MariaAuthorCarneado-Ruiz, JoaquinAuthorVivancos-Mora, JoseAuthorDiez-Tejedor, ExuperioAuthor

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May 31, 2020
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Prehospital selection of thrombectomy candidates beyond large vessel occlusion: M-DIRECT scale

Publicated to:NEUROLOGY. 94 (8): E851-E860 - 2020-02-25 94(8), DOI: 10.1212/WNL.0000000000008998

Authors: Rodriguez-Pardo, Jorge; Riera-Lopez, Nicolas; Fuentes, Blanca; Alonso de Lecinana, Maria; Secades-Garcia, Sergio; Alvarez-Fraga, Julia; Busca-Ostolaza, Pablo; Carneado-Ruiz, Joaquin; Diaz-Guzman, Jaime; Egido-Herrero, Jose; Gil-Nunez, Antonio; Masjuan-Vallejo, Jaime; Real-Martinez, Veronica; Vivancos-Mora, Jose; Diez-Tejedor, Exuperio

Affiliations

Serv Emergencias Med SUMMA 112, Stroke Code Coordinat Ctr, Madrid, Spain - Author
Univ Alcala De Henares, Dept Neurol, Hosp Univ Ramon & Cajal, Alcala De Henares, Spain - Author
Univ Autonoma Madrid, Dept Neurol, Hosp Univ La Paz, Madrid, Spain - Author
Univ Autonoma Madrid, Dept Neurol, Hosp Univ La Princesa, Madrid, Spain - Author
Univ Autonoma Madrid, Dept Neurol, Hosp Univ Puerta de Hierro Majadahonda, Madrid, Spain - Author
Univ Complutense Madrid, Dept Neurol, Hosp Univ Clin San Carlos, Madrid, Spain - Author
Univ Complutense Madrid, Dept Neurol, Hosp Univ Doce Octubre, Madrid, Spain - Author
Univ Complutense Madrid, Dept Neurol, Hosp Univ Gregorio Maranon, Madrid, Spain - Author
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Abstract

ObjectiveCurrent prehospital scales used to detect large vessel occlusion reveal very low endovascular thrombectomy (EVT) rates among selected patients. We developed a novel prehospital scale, the Madrid-Direct Referral to Endovascular Center (M-DIRECT), to identify EVT candidates for direct transfer to EVT-capable centers (EVT-Cs). The scale evaluated clinical examination, systolic blood pressure, and age. Since March 2017, patients closer to a stroke unit without EVT capabilities and an M-DIRECT positive score have been transferred to the nearest EVT-C. To test the performance of the scale-based routing protocol, we compared its outcomes with those of a simultaneous cohort of patients directly transferred to an EVT-C.MethodsIn this prospective observational study of consecutive patients with stroke code seen by emergency medical services, we compared diagnoses, treatments, and outcomes of patients who were closer to an EVT-C (mothership cohort) with those transferred according to the M-DIRECT score (M-DIRECT cohort).ResultsThe M-DIRECT cohort included 327 patients and the mothership cohort 214 patients. In the M-DIRECT cohort, 227 patients were negative and 100 were positive. Twenty-four (10.6%) patients required secondary transfer, leaving 124 (38%) patients from the M-DIRECT cohort admitted to an EVT-C. EVT rates were similar for patients with ischemic stroke in both cohorts (30.9% vs 31.5%). The M-DIRECT scale had 79% sensitivity, 82% specificity, and 53% positive predictive value for EVT. Recanalization and independence rates at 3 months did not differ between the cohorts.ConclusionsThe M-DIRECT scale was highly accurate for EVT, with treatment rates and outcomes similar to those of a mothership paradigm, thereby avoiding EVT-C overload with a low rate of secondary transfers.

Keywords

Acute ischemic-strokeAgedEarly managementEmergency medical servicesEndovascular treatmentFemaleGuidelinesHealth-care professionalsHumansMalePatient selectionPatient transferPredictive value of testsProspective studiesRegistriesSensitivity and specificityStrokeThrombectomyThrombolysisValidation

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal NEUROLOGY due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 12/208, thus managing to position itself as a Q1 (Primer Cuartil), in the category Clinical Neurology. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.28. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.98 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 7.92 (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-03, the following number of citations:

  • WoS: 27
  • Scopus: 26
  • Europe PMC: 9

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-03:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 63.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 62 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 20.45.
  • The number of mentions on the social network X (formerly Twitter): 14 (Altmetric).
  • The number of mentions in news outlets: 1 (Altmetric).

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Rodriguez-Pardo, Jorge) .

the authors responsible for correspondence tasks have been Rodriguez-Pardo, Jorge and FUENTES GIMENO, BLANCA EULALIA.