Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY
Jørgen Ibsen, Maren Ranhoff Hov, Gunn Eli Tokerud, Julia Fuglum, Marianne Linnerud Krogstad, Marie Stugaard, Hege Ihle-Hansen, Christian Georg Lund, Christian Hall
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Abstract

Background: Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for disability-preventing thrombolytic therapy due to prolonged transport times.

Methods: Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017-2021 into a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT scanner (the Reference group).

Results: A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and 69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference group (p < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median 124 min in the Rural CT group and 213 min in the Reference group, p < 0.05. The frequency of thrombolysis for ischemic stroke did not significantly differ between the two groups.

Conclusion: Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.

在农村地区进行院前计算机断层扫描,以快速诊断和治疗中风。
背景:缺血性脑卒中患者的早期诊断和分流对于快速再灌注治疗至关重要。院前延误的时间可能很长,来自农村地区的患者由于转运时间过长,往往来不及到当地医院接受预防残疾的溶栓治疗。我们在 HDMC 建立了对急性缺血性中风患者进行 CT 成像和溶栓治疗的紧急路径。在上班时间,这些路径由一名放射技师和一名全科医生通过视频会议从初级卒中中心提供支持。非办公时间,我们远程控制 CT 检查,并支持远程卒中指导护理人员处理和检查患者。为了证明这一全新理念的可行性,我们在 2017-2021 年期间招募患者参与一项队列比较观察研究。我们将在HDMC接受治疗的患者(农村CT组)与挪威另外两个农村地区的患者(参照组)进行了比较,这两个地区距离当地医院的距离相似,但没有农村CT扫描仪:农村 CT 组共有 86 名患者(平均年龄 74 岁,52% 为男性,43% 为中风模拟患者),参照组共有 69 名患者(平均年龄 70 岁,42% 为男性,28% 为中风模拟患者)。农村 CT 组患者从症状出现到完成 CT 检查的中位时间为 93 分钟,而参照组患者为 240 分钟(P P 结论:将院前农村 CT 检查与远程卒中指导诊断和辅助医务人员溶栓治疗相结合,有助于缺血性卒中患者更早地开始溶栓治疗。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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