Short summary

We perform this clusterrandomised study to examine whether video call assisted assessment of patients suspected of stroke in a prehospital setting can select patients for thrombectomy.

Rationale

Stroke is the fourth leading cause of death in Denmark and each year approximately 12.000 Danes suffer a stroke. This corresponds to 33 people every day. Moreover, stroke is the most frequent diagnosis causing disability in the adult population.

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 large vessel occlusions (LVOs) are currently being investigated and studies trying to determine whether to "drip and ship" or to "mothership" are yet too scarce to draw conclusions. However, it is widely recommended that non-intravenous thrombolysis (IVT) candidates suspected for large vessel occlusion (LVO) fulfilling the criteria for endovascular thrombectomy (EVT) are transported directly to the nearest Comprehensive Stroke Care unit (CSC). Whereas minor stroke and IVT candidates are transported directly to the primary stroke centres (PSCs). Which method is better, though, to evaluate patients suspected of LVO in a prehospital setting?

This study aims to investigate whether a live stream video between the on-call neurologist and the EMTs can increase feasibility and performance of symptom-based prehospital stroke scales to test for LVOs.

Description of the cohort

Patients prehospitally suspected of stroke, symptom onset within 24 hours, in the catchment area of one of the four stroke units in the southern region of Denmark, age > 18 years, no coma (GCS < 9).

Data and biological material

Data from prehospital patient journal and inhospital patient journal including video-evaluation by neurologist and MR/CT scan.

Collaborating researchers and departments

Department of Regional Health Research, University of Southern Denmark, Aabenraa

• Professor Christina B. Mogensen
• Anders N.Ø. Schultz

Emergency Medical Services, Ambulance Syd, Odense

• Daniel Wittrock
• Henning M. Lassesen

The Prehospital Research Unit, Aarhus University Hopital, Aarhus

• ph.d. Martin F. Gude

Department of Neurology, Aarhus University Hospital, Aarhus

• Professor Claus Z. Simonsen

The Prehospital Research Unit, University of Southern Denmark, Odense

• Professor Søren Mikkelsen

Department of Neurology, Odense University Hospital, Odense

• Professor David Gaist

Department of Neurology, University hospital of Southern Denmark, Aabenraa

• Tanja Bender