Video Call Assisted Assessment of Acute Stroke

Not Applicable

Recruiting

Conditions: Stroke
Central Nervous System Diseases
Cerebrovascular Disorders
Brain Diseases
Vascular Diseases
Nervous System Diseases

Interventions: Diagnostic Test: Video call assisted assessment of acute stroke

Brief Summary: 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.

Detailed Description: 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.

Recruitment & Eligibility

Inclusion Criteria

Suspected stroke within 24 hours from onset (confirmed with Prehospital Stroke 1 decision tool)
Age >18 years

Exclusion Criteria

Suspected stroke more than 24 hours ago
In-hospital stroke or private transport to hospital
Unconsciousness defined as Glasgow Coma Score (GCS) ≤ 8 (as they cannot be rated)

Arm && Interventions

Group	Intervention	Description
Video call assisted assessment of acute stroke	Video call assisted assessment of acute stroke	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.

Primary Outcome Measures

Name	Time	Method
Acute ischemic stroke (AIS) or transient ischemic attack (TIA) diagnosis at discharge	At discharge, assessed within one week from symptom onset	AIS or TIA as diagnosis. (binary outcome)

Secondary Outcome Measures

Name	Time	Method
Number of patients with Haemorrhagic stroke	at admission	Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with intra cranial haemorrhage (ICH) (binary outcome)
Number of patients with verified acute ischemic stroke (AIS) on neuroimaging	Within 48 hours of admission	Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with AIS
Number of patients with Other large vessel AIS	at admission	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).
Number of patients with acute ischemic stroke (AIS) with LVO on neuroimaging	Within 48 hours of admission	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).