Einsatz mobiler Computing-Systeme in der präklinischen Schlaganfallversorgung

Ziegler, Volker; Rashid, Asarnusch; Müller-Gorchs, Mercè; Kippnich, Uwe; Hiermann, Erich; Kögerl, C.; Holtmann, Christoph; Siebler, Mario; Griewing, B.

doi:10.1007/s00101-008-1395-x

Cited by 54 publications

(14 citation statements)

References 17 publications

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“…Duration of patient transport was comparable to previously published data [8,26]. Half of the TCCS examinations were performed at the primary site of the stroke incident and most were finished before the first-aid personnel arrived with the stretcher.…”

Section: Discussionsupporting

confidence: 68%

Transcranial Ultrasound from Diagnosis to Early Stroke Treatment – Part 2: Prehospital Neurosonography in Patients with Acute Stroke – The Regensburg Stroke Mobile Project

et al. 2012

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Background and Purpose: The primary aim of this study was to investigate the diagnostic accuracy and time frames for neurological and transcranial color-coded sonography (TCCS) assessments in a prehospital ‘911’ emergency stroke situation by using portable duplex ultrasound devices to visualize the bilateral middle cerebral arteries (MCAs). Methods: This study was conducted between May 2010 and January 2011. Patients who had sustained strokes in the city of Regensburg and the surrounding area in Bavaria, Germany, were enrolled in the study. After a ‘911 stroke code’ call had been dispatched, stroke neurologists with expertise in ultrasonography rendezvoused with the paramedic team at the site of the emergency. After a brief neurological assessment had been completed, the patients underwent TCCS with optional administration of an ultrasound contrast agent in cases of insufficient temporal bone windows or if the agent had acute therapeutic relevance. The ultrasound studies were performed at the site of the emergency or in the ambulance during patient transport to the admitting hospital. Relevant timelines, such as the time from the stroke alarm to patient arrival at the hospital and the duration of the TCCS, were documented, and positive and negative predictive values for the diagnosis of major MCA occlusion were assessed. Results: A total of 113 patients were enrolled in the study. MCA occlusion was diagnosed in 10 patients. In 9 of these 10 patients, MCA occlusion could be visualized using contrast-enhanced or non-contrast-enhanced TCCS during patient transport and was later confirmed using computed tomography or magnetic resonance angiography. One MCA occlusion was missed by TCCS and 1 atypical hemorrhage was misdiagnosed. Overall, the sensitivity of a ‘field diagnosis’ of MCA occlusion was 90% [95% confidence interval (CI) 55.5–99.75%] and the specificity was 98% (95% CI 92.89–99.97%). The positive predictive value was 90% (95% CI 55.5–99.75%) and the negative predictive value was 98% (95% CI 92.89–99.97%). The mean time (standard deviation) from ambulance dispatch to arrival at the patient was 12.3 min (7.09); the mean time for the TCCS examination was 5.6 min (2.2); and the overall mean transport time to the hospital was 53 min (18). Conclusion: Prehospital diagnosis of MCA occlusion in stroke patients is feasible using portable duplex ultrasonography with or without administration of a microbubble contrast agent. Prehospital neurological as well as transcranial vascular assessments during patient transport can be performed by a trained neurologist with high sensitivity and specificity, perhaps opening an additional therapeutic window for sonothrombolysis or neuroprotective strategies.

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Section: Discussionsupporting

confidence: 68%

Transcranial Ultrasound from Diagnosis to Early Stroke Treatment – Part 2: Prehospital Neurosonography in Patients with Acute Stroke – The Regensburg Stroke Mobile Project

et al. 2012

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“…Examples include the Stroke Angel project [39], STEMO [40], Mobile Stroke Unit (MSU) [41], Aster (http://www.aster-magdeburg.de), and Med-on-@ix [42] projects. All these projects differ in concept, personnel required, timelines, and costs.…”

Section: Resultsmentioning

confidence: 99%

Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound

et al. 2014

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BackgroundTranscranial color-coded sonography (TCCS) has proved to be a fast and reliable tool for the detection of middle cerebral artery (MCA) occlusions in a hospital setting. In this feasibility study on prehospital sonography, our aim was to investigate the accuracy of TCCS for neurovascular emergency diagnostics when performed in a prehospital setting using mobile ultrasound equipment as part of a neurological examination.MethodsFollowing a ‘911 stroke code’ call, stroke neurologists experienced in TCCS rendezvoused with the paramedic team. In patients with suspected stroke, TCCS examination including ultrasound contrast agents was performed. Results were compared with neurovascular imaging (CTA, MRA) and the final discharge diagnosis from standard patient-centered stroke care.ResultsWe enrolled ‘232 stroke code’ patients with follow-up data available in 102 patients with complete TCCS examination. A diagnosis of ischemic stroke was made in 73 cases; 29 patients were identified as ‘stroke mimics’. MCA occlusion was diagnosed in ten patients, while internal carotid artery (ICA) occlusion/high-grade stenosis leading to reversal of anterior cerebral artery flow was diagnosed in four patients. The initial working diagnosis ‘any stroke’ showed a sensitivity of 94% and a specificity of 48%. ‘Major MCA or ICA stroke’ diagnosed by mobile ultrasound showed an overall sensitivity of 78% and specificity of 98%.ConclusionsThe study demonstrates the feasibility and high diagnostic accuracy of emergency transcranial ultrasound assessment combined with neurological examinations for major ischemic stroke. Future combination with telemedical support, point-of-care analysis of blood serum markers, and probability algorithms of prehospital stroke diagnosis including ultrasound may help to speed up stroke treatment.

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“…It has been shown in one study that the Cincinnati Prehospital Stroke Scale can be accurately assessed by lay people if guided via telephone by a trained investigator [17]. A telemedicine approach was tested in the Stroke Angel project [18] using an electronic transmission of the score and other items to a stroke center. The sensitivity (69%) and specificity (85%) of the Los Angeles Prehospital Stroke Screen remained unsatisfactory but the advanced notification of the stroke team was associated with improved in-hospital delays and thrombolysis rates (from 6 to 11% of all acute stroke patients).…”

Section: Use Of Telemedicine In Prehospital Stroke Carementioning

confidence: 99%

Telestroke: Scientific Results

Audebert

Schwamm

2009

Cerebrovasc Dis

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Telestroke is the application of telemedicine in stroke care. Hence, teleconsultation means the performance of consultation by a remotely located expert through the use of high-quality videoconferencing. Remote evaluation of stroke patients via telemedicine is increasingly utilized, particularly in neurologically underserved areas. It is usually based on video examination and evaluations of brain scans via teleradiology. Scientific analyses have demonstrated the reliability of neurological assessments via videoconference. Teleradiology using electronically transmitted original imaging data is potentially equivalent to onsite assessment. Telemedicine consultation including video examination and teleradiology improves accuracy of acute stroke treatment decisions compared to telephone-based consultation. Telemedicine is already frequently used to extend the benefits of intravenous thrombolysis to patients in nonspecialized hospitals. Beyond thrombolysis, telemedicine can be used for immediate decision making in acute stroke, e.g. for triage of patients who might benefit from interventional treatments not available at the referring hospital. However, improved clinical outcomes of stroke patients have only been investigated and shown when telemedicine was combined with the Stroke Unit concept based on specialized stroke wards and organized stroke care. More scientific evaluation is needed in the fields of cost effectiveness, quality management and implementation of further technological innovations. There are still insufficient data about the use of telemedicine in stroke prevention, rehabilitation and post-stroke care.

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Einsatz mobiler Computing-Systeme in der präklinischen Schlaganfallversorgung

Cited by 54 publications

References 17 publications

Transcranial Ultrasound from Diagnosis to Early Stroke Treatment – Part 2: Prehospital Neurosonography in Patients with Acute Stroke – The Regensburg Stroke Mobile Project

Transcranial Ultrasound from Diagnosis to Early Stroke Treatment – Part 2: Prehospital Neurosonography in Patients with Acute Stroke – The Regensburg Stroke Mobile Project

Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound

Telestroke: Scientific Results

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