Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Yperzeele, Laetitia; Hooff, Robbert-Jan Van; Smedt, Ann De; Espinoza, Alexis Valenzuela; Casseye, Rohny Van de; Hubloue, Ives; Keyser, Jacques De; Brouns, Raf

doi:10.1159/000363617

Cited by 38 publications

(28 citation statements)

References 83 publications

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“…The fear to miss an atypical stroke presentation might lead to an overestimation of acute stroke as similarly seen in our study, since EMS might prefer to announce too many patients as acute stroke, rather than to miss the diagnosis once [19] . Prehospital telemedicine might be an upcoming option to optimize prehospital assessment [20] .…”

Section: Discussionmentioning

confidence: 99%

Is It Acute Stroke or Not? - A Prospective Observational Study from a Multidisciplinary Emergency Department

Wolf¹,

Chatzikonstantinou²,

Grüttner

et al. 2016

Eur Neurol

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Background: Acute stroke is a medical emergency with various clinical presentations. Since the introduction of systemic thrombolytic treatment, stroke diagnosis has been made quickly and with great caution, and the trend of rapid presentation at hospitals has increased. Methods: In our multidisciplinary Emergency Department, we prospectively collected and analysed data of consecutive patients presenting with suspected acute stroke (SAS) or transient ischemic attack (TIA). Results: Four hundred ten patients (200 men, mean age 68 ± 16, range 17-93 years) with SAS were admitted of which 105 were prehospitally announced as within the time-window for thrombolytic treatment (TW). Diagnosis of acute stroke/TIA was retained in 147 (35.9%). The initially reported TW <4.5 h was wrong in 35.3%. Thrombolysis was performed in 27 patients (23.5% of ischemic stroke patients; 6.6% of all SAS). Diagnosis of another neurologic disease was made in 62 (15.1%). Major differential diagnoses came from the field of internal medicine, psychiatry or otorhinolaryngology. One hundred fifty patients (36.6%) were rapidly discharged. Conclusion: About half the number of our patients admitted for SAS did not suffer from an acute neurologic disease. Residual symptoms post-stroke might be partly responsible for initial misinterpretation. The crucial difference between symptom onset and symptom recognition needs to be emphasized to improve the prehospital assessment of the TW.

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Section: Discussionmentioning

confidence: 99%

Is It Acute Stroke or Not? - A Prospective Observational Study from a Multidisciplinary Emergency Department

Wolf¹,

Chatzikonstantinou²,

Grüttner

et al. 2016

Eur Neurol

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“…Finally, as the overall time between symptom onset and recanalization determines outcome of the patients, also measures to reduce pre-hospital delays have to be investigated [30] .…”

Section: Discussionmentioning

confidence: 99%

‘Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment

Ragoschke-Schumm¹,

Yılmaz²,

Kostopoulos³

et al. 2015

Cerebrovasc Dis

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Background: For patients with acute ischemic stroke, intra-arterial treatment (IAT) is considered to be an effective strategy for removing the obstructing clot. Because outcome crucially depends on time to treatment (‘time-is-brain' concept), we assessed the effects of an intervention based on performing all the time-sensitive diagnostic and therapeutic procedures at a single location on the delay before intra-arterial stroke treatment. Methods: Consecutive acute stroke patients with large vessel occlusion who obtained IAT were evaluated before and after implementation (April 26, 2010) of an intervention focused on performing all the diagnostic and therapeutic measures at a single site (‘stroke room'). Result: After implementation of the intervention, the median intervals between admission and first angiography series were significantly shorter for 174 intervention patients (102 min, interquartile range (IQR) 85-120 min) than for 81 control patients (117 min, IQR 89-150 min; p < 0.05), as were the intervals between admission and clot removal or end of angiography (152 min, IQR 123-185 min vs. 190 min, IQR 163-227 min; p < 0.001). However, no significant differences in clinical outcome were observed. Conclusion: This study shows for the, to our knowledge, first time that for patients with acute ischemic stroke, stroke diagnosis and treatment at a single location (‘stroke room') saves crucial time until IAT.

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“…However, no Scottish hospital meets this target currently (average = 29%) 7 . Given the time pressure in assessing and treating stroke, and the fact that there is already considerable pressure on CT scanners, there is a growing movement towards doing more for stroke patients before they arrive at hospital 8 .…”

Section: The Burden Of Stroke and The Assessment And Treatment Of Strmentioning

confidence: 99%

“…A range of telestrokespecific scales are also available, such as the Unassisted TeleStroke Scale (UTSS), which has good correlation with the NIHSS and takes around half the time to complete (3.1 vs. 8.5 minutes, p<0.001) 21 . Yperzeele et al in their review of pre-hospital stroke care described three generations of telestroke technology 8 , the first two of which saw communication over fixed landline (1.0) and the World Wide Web (2.0) but only for patients who had already arrived at hospital. Telestroke 3.0 moves into the pre-hospital context but only a very limited amount of research has been conducted thus far.…”

Section: Technology To Access Remote Expert Advice In Pre-hospital Stmentioning

confidence: 99%

Combining transcranial ultrasound with intelligent communication methods to enhance the remote assessment and management of stroke patients: Framework for a technology demonstrator

Mort

Eadie

Regan

et al. 2016

Health Informatics J

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With over 150,000 strokes in the UK every year, and more than 1 million living survivors, stroke is the third most common cause of death and the leading cause of severe physical disability among adults. A major challenge in administering timely treatment is determining whether the stroke is due to vascular blockage (ischaemic) or haemorrhage. For patients with ischemic stroke, thrombolysis (i.e. pharmacological 'clot-busting') can improve outcomes when delivered swiftly after onset and current NHS Quality Improvement Scotland guidelines are for thrombolytic therapy to be provided to at least 80% of eligible patients within 60 minutes of arrival at hospital. Thrombolysis in haemorrhagic stroke could severely compound the brain damage so administration of thrombolytic therapy currently requires near immediate care in a hospital, rapid consultation with a physician and access to imaging services (X-ray computed tomography (CT) or magnetic resonance imaging) and intensive care services. This is near impossible in remote and rural areas, and stroke mortality rates in Scotland are 50% higher than in London. We here describe our current project developing a technology demonstrator with ultrasound imaging linked to an intelligent, multi-channel communications device − connecting to multiple 2G/3G/4G networks and/or satellites − in order to stream live ultrasound images, video and two-way audio streams to hospital-based specialists who can guide and advise ambulance clinicians regarding diagnosis. With portable ultrasound machines located in ambulances or general practices, use of such technology is not confined to stroke, although this is our current focus. Ultrasound assessment is useful in many other immediate care situations, suggesting potential wider applicability for this remote support system. Although our research programme is driven by rural need, the ideas are potentially applicable to urban areas where access to imaging and definitive treatment can be restricted by a range of operational factors.

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Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Cited by 38 publications

References 83 publications

Is It Acute Stroke or Not? - A Prospective Observational Study from a Multidisciplinary Emergency Department

Is It Acute Stroke or Not? - A Prospective Observational Study from a Multidisciplinary Emergency Department

‘Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment

Combining transcranial ultrasound with intelligent communication methods to enhance the remote assessment and management of stroke patients: Framework for a technology demonstrator

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