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.
Suspected stroke within 24 hours from onset (confirmed with Prehospital Stroke 1 decision tool)
Age >18 years
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)
Parallel
Video call assisted assessment of acute stroke
Diagnostic testIf the patient is eligible for study inclusion, eight 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 via the video-call and triages the patient.
Acute ischemic stroke (AIS) or transient ischemic attack (TIA) diagnosis at discharge
AIS or TIA as diagnosis. (binary outcome)
Number of patients with acute ischemic stroke (AIS) with LVO on neuroimaging
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).
Number of patients with Other large vessel AIS
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 verified acute ischemic stroke (AIS) on neuroimaging
Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with AIS
Number of patients with Haemorrhagic stroke
Neuroimaging (computer tomography (CT), CT angiography, magnetic resonance imaging (MRi), MR angiography or catheter-based angiography) with intra cranial haemorrhage (ICH) (binary outcome)
Duration of examination on video-call
Duration of examination on video-call measured in minutes (continuous outcome)
Number of patients which have mimic mistaken for stroke
Mimic mistaken for stroke evaluated as discrepancy between stroke as tentative diagnoses at primary contact from EMS and final diagnosis at discharge
Prehospital time on scene
Time on scene from arrival EMS to departure EMS measured in minutes (continuous outcome)
Type of department patient is admitted to after consultation with the neurologist
Where was the patient sent after telephone/video consultation with the on-call neurologist.
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