PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II

Abstract

RationaleStroke is a time-critical medical emergency requiring specialized treatment. Prehospital delay contributes significantly to delayed or missed treatment opportunities. In-ambulance telemedicine can bring stroke expertise to the prehospital arena and facilitate this complex diagnostic and therapeutic process.AimsThis study evaluates the efficacy, safety, feasibility, reliability and cost-effectiveness of in-ambulance telemedicine for patients with suspicion of acute stroke. We hypothesize that this approach will reduce the delay to in-hospital treatment by streamlining the diagnostic process and that prehospital stroke care will be improved by expert stroke support via telemedicine during the ambulance transportation.DesignPreSSUB II is an interventional, prospective, randomized, open-blinded, end-point, single-center trial comparing standard emergency care by the Paramedic Intervention Team of the Universitair Ziekenhuis Brussel (control) with standard emergency care complemented with in-ambulance teleconsultation service by stroke experts (PreSSUB).Study OutcomesThe primary efficacy endpoint is the call-to-brain imaging time. Secondary endpoints for the efficacy analysis include the prevalence of medical events diagnosed and corrected during in-ambulance teleconsultation, the proportion of patients with ischemic stroke receiving recanalization therapy, the assessment of disability, functional status, quality of life and overall well-being. Mortality at 90 days after stroke is the primary safety endpoint. Secondary safety analysis will involve the registration of any adverse event. Other analyses include assessment of feasibility and reliability and a health economic evaluation.

A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke

“…Technologies employed by included studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] were best described using three categories: blood biomarkers [22,23]; pre-hospital imaging [24,25] and mobile telemedicine/telestroke (including transfer of audio and/or visual information or relevant data) [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. These are summarised in Table 1. Most studies were conducted in the USA [24,26,27,[34][35][36][37][38][39], followed by Germany [28]…”

“…We identified 12 mobile telemedicine technologies reported across 15 studies [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Descriptions are summarised in Table 4.…”

“…Results not yet available transferred from the ambulance to hospital. Earlier studies [26][27][28][29][30] utilised technology with lower resolution and slower transmission speeds than later studies [31][32][33][34][35][36][37][38][39][40] employing contemporary technology such as high definition, bi-directional video communication and 4G networks. Systems were either purpose-built or adapted from commercially available technology (e.g.…”

“…A 14-item stroke history checklist was developed by experts based on published checklists and recommendations and evaluated for use in conjunction with the 'peeq-box' system [28]. The PreSSUB I and II studies [31,32] developed and evaluated the Unassisted Telestroke Scale; included items were based on existing stroke scales and evaluation of their appropriateness by experts [45,46].…”

“…Time metrics were reported for 11 of 15 telestroke studies [28][29][30][31][32][33][34][36][37][38][39]. Duration of telestroke consultation was reported in three [31,34,36].…”