Assessment of acute stroke cerebral CT examinations by anaesthesiologists

Abstract

Background and purposeIt is essential to diagnose ischaemic stroke as soon as possible after symptom onset, so that thrombolytic treatment can be initiated as quickly as possible. This might be greatly facilitated if cerebral CT could be carried out in a pre‐hospital setting. The aim of this study was to evaluate if anaesthesiologists, who in Norway provide pre‐hospital medical care, could be trained to assess cerebral CT scans to exclude radiological contraindications for thrombolytic stroke treatment.MethodsThirteen anaesthesiologists attended an 8‐h course in acute stroke assessment, including a 2‐h introduction to the neuroradiology of acute stroke. Each participant then assessed 12 non‐contrast cerebral CT examinations of acute stroke patients with specific regard to radiological contraindications for thrombolytic therapy. Test results were compared with those of three experienced neuroradiologists. Inter‐rater agreement between anaesthesiologists and neuroradiologists was calculated using Cohen's Kappa statistics. Robustness of the results was assessed using the non‐parametric bootstrap.ResultsAmong the neuroradiologists, Kappa was 1 for detecting radiological contraindications for thrombolytic therapy. Twelve of the 13 anaesthesiologists showed good or excellent agreement (Kappa > 0.60) with the neuroradiologists. The anaesthesiologists spent a median time of 2 min and 18 s on each CT scan.ConclusionsThis study suggests that anaesthesiologists who are experienced in pre‐hospital care may be quickly trained to assess cerebral CT examinations in acute stroke patients with regard to radiological contraindications for thrombolytic therapy.

First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

“…Because the administration of prehospital thrombolysis is increasingly being studied at many stroke centers in several countries [3,6,7,8,9,10,11,12,13,14], the availability of a tool that could evaluate CT images and detect signs of infarction in an ambulance in a standardized manner would be of considerable medical interest. This study demonstrates the feasibility and potential clinical benefit of integrating the e-ASPECTS software for the automated detection of early ischemic damage in a MSU.…”

“…This work was part of the prehospital stroke treatment program in which the MSU was dispatched mainly to hyperacute stroke patients. Moreover, the response times of the MSU and the times to diagnostic work-up are faster than those in the conventional hospital approach [6,7,8,9,10,11,12,13,14]. Indeed, the finding of very high e-ASPECTS values matched with the findings of median scores of 9 in a recent thrombectomy study, in which response times were also very short (median symptom onset-to-needle times of 85 min) [30].…”

“…Currently, programs for prehospital stroke treatment are in operation at several stroke centers [7,8,9,10,11,12,13,14]. Reports from these programs confirm the enormous time gain associated with prehospital stroke treatment and show that treatment rates can be significantly increased [9].…”

For en bedre akuttmedisinsk tjeneste i Norge

“…Det trengs ingen radiograf for å gjennomføre en CT-undersøkelse, slik at utgiftene vil begrense seg til innkjøp og vedlikehold av CT-maskin. Norsk forskning i regi av Stiftelsen Norsk Luftambulanse har vist at anestesileger lett kan laere å ta og tolke CT-bilder av akutte hjerneslagpasienter (Hov et al, 2015). CTbasene vil etablere direkte teleradiologi med regionsykehuset i helseforetaket.…”

Prehospital Imaging‐Based Triage of Head Trauma with a Mobile Stroke Unit: First Evidence and Literature Review

“…Currently, several programs for prehospital stroke diagnosis and treatment are in operation (in Berlin since 2011, in Frederikshavn, Norway, since 2013, in Houston, Texas, since 2014, and in Cleveland, Ohio, since 2014), and several other ambulances have been implemented or are being planned. Additional studies have confirmed that such programs have resulted in an enormous time gain and that treatment rates have increased significantly …”