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

Schwindling, Lenka; Ragoschke-Schumm, Andreas; Kettner, Mattias; Helwig, Stefan A.; Manitz, Matthias; Roumia, Safwan; Lesmeister, Martin; Grunwald, Iris Q.; Faßbender, Klaus

doi:10.1111/jon.12355

Cited by 29 publications

(18 citation statements)

References 49 publications

(91 reference statements)

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“…In the PHANTOM-S study, referral of ICH to the appropriate hospital increased from 11% to 43% when the imaging information in the MSU revealed ICH 10 11. Similarly, early diagnosis can help in initiation of time-sensitive therapies in other neurological conditions including brain trauma and status epilepticus 12. Lastly, the MSU is a costly technology and a detailed economic evaluation of the project is under way.…”

Section: Discussionmentioning

confidence: 99%

Mobile stroke unit triage of patients with a suspected stroke: a novel solution to reducing suspected stroke admissions in busy emergency departments

et al. 2018

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BackgroundEvaluation of patients with a suspected stroke is one of the most common neurological emergencies requiring rapid, comprehensive assessment by the stroke service to determine patient eligibility for timely reperfusion therapies. Prehospital evaluation may help to improve patient selection and reduce avoidable admissions to overcapacity emergency departments.Methods and resultsWe report on our early experience of prehospital triage of patients with a suspected stroke using a mobile stroke unit (MSU) equipped with CT scanner in rural Alberta. During the initial 4 months of operation, 28 patients were evaluated by the team in the MSU. Eight patients were within the time window of thrombolysis and were treated with intravenous tissue plasminogen activator in the MSU. No patients suffered haemorrhage or any other complications. Fourteen patients with multiple aetiologies (stroke mimics 6, transient ischaemic attacks 2, subacute stroke outside thrombolysis window 2, intracranial haemorrhage 3 and cerebral contusion 1) were assessed in the field and transferred to the tertiary hospital. Six patients after assessment and imaging were repatriated back to the local hospital as they were deemed stroke mimics or were outside of the reperfusion window.ConclusionsThe MSU offers a novel approach to performing timely evaluation and treatment of patients with a suspected stroke in rural settings and may help reduce admissions to overcapacity tertiary care facilities.

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Section: Discussionmentioning

confidence: 99%

Mobile stroke unit triage of patients with a suspected stroke: a novel solution to reducing suspected stroke admissions in busy emergency departments

et al. 2018

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“…The majority of the papers came from HICs and explored various forms of post-collision pre-hospital care, most of which were on airway management through intubation and ventilation. Other HIC papers looked at pre-hospital triage including one which described the use of a mobile stroke unit for imaging in neurotrauma and pre-hospital fluid resuscitation [62,63]. Another HIC paper was on the direct transport of victims to neurosurgical centres or operating theatres, bypassing nearby hospitals or health facilities [64].…”

Section: Multi-componentmentioning

confidence: 99%

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

et al. 2020

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Background: Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low-and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high-income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs. Methods: A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health on EBSCO host, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).

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“…The majority of the papers came from HICs and explored various forms of pre-hospital care, most of which were on pre-hospital airway management through intubation and ventilation. Other HIC papers looked at pre-hospital triage including one which described the use of a mobile stroke unit for imaging in neurotrauma, and pre-hospital fluid resuscitation [62,63]. Another HIC paper was on the direct transport of victims to neurosurgical centres or operating theatres, bypassing nearby hospitals or health facilities [64].…”

Section: Secondary Preventionmentioning

confidence: 99%

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: A scoping review

Selveindran

Tango

Khan

et al. 2020

Preprint

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Background Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low-and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs.Methods A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health EBSCO, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).Results A total of 411 publications met the inclusion criteria, including 349 primary studies and 62 reviews. More than 80 percent of the primary studies were from HICs, and described all levels of neurotrauma prevention. Only 65 papers came from LMICs, which mostly described primary prevention, focussing on road safety. For the reviews, 41 papers (66.1%) reviewed primary, 18 tertiary (29.1%), and three secondary preventative approaches. Most of the primary papers in the reviews came from HICs (67.7%) with 5 reviews on only LMIC papers. Fifteen reviews (24.1%) included papers from both HICs and LMICs. Intervention settings ranged from nation-wide to community-based, but were not reported in 44 papers (10.8%), most of which were reviews. Contextual factors were described in 62 papers, and varied depending on the interventions.Conclusions There is a large quantity of global evidence on strategies and interventions for neurotrauma and RTCs prevention. However, less papers were from LMICs, especially on secondary and tertiary prevention. More primary research needs to be done in these countries to determine what strategies and interventions exist, and the applicability of HIC interventions in LMICs.

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

Cited by 29 publications

References 49 publications

Mobile stroke unit triage of patients with a suspected stroke: a novel solution to reducing suspected stroke admissions in busy emergency departments

Mobile stroke unit triage of patients with a suspected stroke: a novel solution to reducing suspected stroke admissions in busy emergency departments

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: A scoping review

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