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This study aims to investigate whether a live stream video between the on-call neurologist and the emergency medical technicians can increase feasibility and performance of symptom-based prehospital stroke scales.
Treatment of stroke with either thrombolysis or thrombectomy is highly time-dependent (administration within 4.5 hours and 24 hours from symptom onset, respectively), and morbidity and mortality increase with time from symptom onset to treatment. Hence, prehospital evaluation and transport must be as accurate and rapid as possible in order to minimise time to treatment.
Different triage and transport paradigms for patients with suspected stroke are being investigated and multiple stroke scales have been coined in order to examine patients suspected of stroke in a prehospital setting. However, performance and feasibility vary greatly in different validation studies suggesting that those outcomes are greatly dependent on other factors i.e. acceptance amongst stakeholders, implementation process, patient segment etc. Some recent studies have shown promising results using video solutions between emergency medical services (EMS) personnel and on-call neurologist in examining patients suspected of stroke in the prehospital phase. The investigators will perform this trial to examine whether a video call assisted assessment of patients suspected of stroke in a prehospital setting can increase feasibility and performance of symptom-based prehospital stroke scales.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Care | No Intervention | If the patient is eligible for study inclusion, eight symptoms from the study protocol are evaluated and registered in the Prehospital Patient Journal (PPJ) on the amPHITM Prehospital Health Care Record (Amphi Systems, Hasserisvej 125, 9000 Aalborg, Denmark), on a tablet mounted in each EMT vehicle. If the vehicle is in the control arm the patient is triaged by the on-call neurologist based on a standard telephone call | |
| Video call assisted assessment of acute stroke | Active Comparator | If the patient is eligible for study inclusion, the last symptoms from the study protocol are evaluated and registered in the Prehospital Patient Journal (PPJ) on the amPHITM Prehospital Health Care Record (Amphi Systems, Hasserisvej 125, 9000 Aalborg, Denmark), on a tablet mounted in each EMT vehicle. Afterwards the EMS personnel will contact the on-call neurologist and if the vehicle is in the intervention arm a live video stream is initiated. The on-call neurologist then examines the patient via the video-call and triage the patient. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Video call assisted assessment of acute stroke | Diagnostic Test | If the patient is eligible for study inclusion, eight symptoms from the study protocol are evaluated and registered in the Prehospital Patient Journal (PPJ) on the amPHITM Prehospital Health Care Record (Amphi Systems, Hasserisvej 125, 9000 Aalborg, Denmark), on a tablet mounted in each EMT vehicle. Afterwards, the EMS personnel will contact the on-call neurologist and if the vehicle is in the intervention arm a live video stream is initiated. The on-call neurologist then examines the patient via via the video-call and triages the patient. |
| Measure | Description | Time Frame |
|---|---|---|
| Acute ischemic stroke (AIS) or transient ischemic attack (TIA) diagnosis at discharge | AIS or TIA as diagnosis. (binary outcome) | At discharge, assessed within one week from symptom onset |
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with acute ischemic stroke (AIS) with LVO on neuroimaging | AIS with LVO on neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography). LVO is defined as a occlusion or sub-occlusion of the intracranial internal carotid artery, middle cerebral artery M1 or M2, basilar artery. Sign of dense cerebral artery on CT is also considered LVO positive. (binary outcome). |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of examination on video-call | Duration of examination on video-call measured in minutes (continuous outcome) | up to 120 minutes prior to admission (prehospital phase) |
| Number of patients which have mimic mistaken for stroke |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Trine Nielsen | Contact | +45 79 97 00 00 | Trine.Nielsen2@rsyd.dk | |
| Christian Backer Mogensen | Contact | +45 79 97 00 00 | CBM1@rsyd.dk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Neurology | Recruiting | Aabenraa | Region Syddanmark | 6200 | Denmark |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002493 | Central Nervous System Diseases |
| ID | Term |
|---|---|
| D002318 | Cardiovascular Diseases |
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|
| Within 48 hours of admission |
| Number of patients with Other large vessel AIS | Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with AIS with occlusion or sub-occlusion of either anterior cerebral artery A1 or A2, posterior cortical artery P1 or intracranial vertebral artery (binary outcome). | at admission |
| Number of patients with verified acute ischemic stroke (AIS) on neuroimaging | Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with AIS | Within 48 hours of admission |
| Number of patients with Haemorrhagic stroke | Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with intra cranial haemorrhage (ICH) (binary outcome) | at admission |
Mimic mistaken for stroke evaluated as discrepancy between stroke as tentative diagnoses at primary contact from EMS and final diagnosis at discharge
| Through study completion, approximately 2 months |
| Prehospital time on scene | Time on scene from arrival EMS to departure EMS measured in minutes (continuous outcome) | up to 120 minutes prior to admission (prehospital phase) |
| Type of department patient is admitted to after consultation with the neurologist | Where was the patient sent after telephone/video consultation with the on-call neurologist. | At admission |
| Door-in-door-out (DIDO) time | DIDO times for patients subsequently sent to comprehensive stroke unit for thrombectomy treatment. | at admission |
| Door-to-needle (DNT) time | DNT times for patients receiving thrombolysis | at admission |
| Door-to-Groin-Puncture (DTGP) time | DTGP times for patients receiving treatment with thrombectomy | within 24 hours of admission |
| Onset-to-Groin-Puncture (OTP) time | OTP for patients receiving treatment with thrombectomy | within 24 hours of admission |
| 90 days modified Ranking Scale (mRS) | Modified Rankin Scale score in stroke patients as evaluated through a structured telephone-based interview performed by a central assessor who is blinded to group assignment | 90 days post admission date |