Real-time video analysis allows the identification of large vessel occlusion in patients with suspected stroke: feasibility trial of a “telestroke” pathway in Northwestern Switzerland

Frontiers in Neurology

Neurology

Marc Luethy¹  Sabine Schädelin²  Christian Nickel³  Fabian Schaub⁴  Joachim Fladt⁴  Sebastian Thilemann⁴  Philippe Lyrer⁴  Nils Peters⁴  Lukas Nussbaum⁴  Leo Bonati⁴  Stefan Engelter⁵  Christoph Kenan Traenka⁵  Gian Marco De Marchis⁶  Axel Ernst⁷  Patrick Hunziker⁸ 

[1] Anaesthesiology, University Hospital Basel, Switzerland and Emergency Medical Service (EMS) Basel, Basel, Switzerland;Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland;Department of Emergency, University Hospital Basel, University of Basel, Basel, Switzerland;Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland;Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland;Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland;Department of Neurology and Stroke Center, University Hospital St Gallen, St. Gallen, Switzerland;ICT Service and Support, University Hospital Basel, Basel, Switzerland;Medical Intensive Care Units, University Hospital Basel, Basel, Switzerland;

关键词: telestroke;    telemedicine;    LVO;    stroke;    pre-hospital;    triage;    treatment;   

DOI  :  10.3389/fneur.2023.1232401

 received in 2023-05-31, accepted in 2023-09-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background and aimLoss of time is a major obstacle to efficient stroke treatment. Our telestroke path intends to optimize prehospital triage using a video link connecting ambulance personnel and a stroke physician. The objectives were as follows: (1) To identify patients suffering a stroke and (2) in particular large vessel occlusion (LVO) strokes as candidates for endovascular treatment. We have chosen the Rapid Arterial Occlusion Evaluation (RACE) scale for this purpose.MethodsThis analysis aimed to verify the feasibility of prehospital stroke identification by video assessment. In this prospective telestroke cohort study, we included 97 subjects, in which the RACE score (items: facial palsy, arm and leg motor function, head and gaze deviation, and aphasia or agnosia) was applied, and the assessment videotaped by a trained member of the Emergency Medical Services (EMS) in the field using a mobile device. Each recorded patient video was independently assessed by three experienced stroke physicians from a certified stroke center and compared to the neuroimaging gold standard. Within this feasibility study, the stroke code was not altered by the outcome of the RACE assessment, and all patients underwent the standard procedures within the emergency unit.ResultsWe analyzed 97 patients (median age 78 years, 53% women), of whom 51 (52.6%) suffered an acute stroke, 12 (23.5%) of which were due to an LVO and 46 patients had symptoms mimicking a stroke. The sensitivity of stroke identification was 77.8%, and specificity was 53.6%. In regard to the identification of an LVO, sensitivity was 69.4% and specificity was 84.3%. The inter-rater agreement in the RACE-score assessment was ICC = 0.82 (intraclass-correlation coefficient).ConclusionThese results confirm our hypothesis that the local telestroke concept is feasible. It allows correct (i) stroke and (ii) LVO identification in the majority of the cases and thus has the potential to assist in efficient prehospital triage.

【 授权许可】

Unknown   
Copyright © 2023 Thilemann, Traenka, Schaub, Nussbaum, Bonati, Peters, Fladt, Nickel, Hunziker, Luethy, Schädelin, Ernst, Engelter, De Marchis and Lyrer.