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Wells B, Nasreldein A, Hall JR, Bachhuber M, Khedr EM, Abd-Allah F, Fassbender KC, van Wijck F, Walter S. Challenges in Prehospital Diagnosis of Acute Stroke in Women: A Case-Based Reflection. Stroke 2024; 55:e238-e241. [PMID: 38818722 DOI: 10.1161/strokeaha.124.046112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Brittany Wells
- Research Centre for Health, Glasgow Caledonian University, Scotland (B.W., J.R.H., F.v.W.)
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom (B.W., S.W.)
- Department of Neurology, Saarland University, Homburg, Germany (B.W., M.B., K.C.F., S.W.)
| | - Ahmed Nasreldein
- Department of Neurology, Assiut University Hospitals, Egypt (A.N., E.M.K.)
| | - Joseph R Hall
- Research Centre for Health, Glasgow Caledonian University, Scotland (B.W., J.R.H., F.v.W.)
| | - Monika Bachhuber
- Department of Neurology, Saarland University, Homburg, Germany (B.W., M.B., K.C.F., S.W.)
| | - Eman M Khedr
- Department of Neurology, Assiut University Hospitals, Egypt (A.N., E.M.K.)
| | - Foad Abd-Allah
- Department of Neurology, Kasralainy School of Medicine, Cairo University, Egypt (F.A.-A.)
| | - Klaus C Fassbender
- Department of Neurology, Saarland University, Homburg, Germany (B.W., M.B., K.C.F., S.W.)
| | - Frederike van Wijck
- Research Centre for Health, Glasgow Caledonian University, Scotland (B.W., J.R.H., F.v.W.)
| | - Silke Walter
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom (B.W., S.W.)
- Department of Neurology, Saarland University, Homburg, Germany (B.W., M.B., K.C.F., S.W.)
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Wenstrup J, Hestoy BH, Sagar MV, Blomberg SNF, Christensen H, Christensen HC, Kruuse C. Emergency Medical Services dispatcher recognition of stroke: A systematic review. Eur Stroke J 2024; 9:283-294. [PMID: 38174575 PMCID: PMC11318428 DOI: 10.1177/23969873231223339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke. METHODS The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument. FINDINGS Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low. DISCUSSION Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented. CONCLUSION While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.
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Affiliation(s)
- Jonathan Wenstrup
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Emergency Medical Services, Copenhagen, Denmark
- Emergency Medical Services, Region Zealand, Denmark
| | - Bartal Hofgaard Hestoy
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Malini Vendela Sagar
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Emergency Medical Services, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Brain- and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Rink JS, Tollens F, Tschalzev A, Bartelt C, Heinzl A, Hoffmann J, Schoenberg SO, Marzina A, Sandikci V, Wiegand C, Hoyer C, Szabo K. Establishing an MSU service in a medium-sized German urban area-clinical and economic considerations. Front Neurol 2024; 15:1358145. [PMID: 38487327 PMCID: PMC10938346 DOI: 10.3389/fneur.2024.1358145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background and purpose Mobile stroke units (MSU) have been demonstrated to improve prehospital stroke care in metropolitan and rural regions. Due to geographical, social and structural idiosyncrasies of the German city of Mannheim, concepts of established MSU services are not directly applicable to the Mannheim initiative. The aim of the present analysis was to identify major determinants that need to be considered when initially setting up a local MSU service. Methods Local stroke statistics from 2015 to 2021 were analyzed and circadian distribution of strokes and local incidence rates were calculated. MSU patient numbers and total program costs were estimated for varying operating modes, daytime coverage models, staffing configurations which included several resource sharing models with the hospital. Additional case-number simulations for expanded catchment areas were performed. Results Median time of symptom onset of ischemic stroke patients was 1:00 p.m. 54.3% of all stroke patients were admitted during a 10-h time window on weekdays. Assuming that MSU is able to reach 53% of stroke patients, the average expected number of ischemic stroke patients admitted to MSU would be 0.64 in a 10-h shift each day, which could potentially be increased by expanding the MSU catchment area. Total estimated MSU costs amounted to € 815,087 per annum. Teleneurological assessment reduced overall costs by 11.7%. Conclusion This analysis provides a framework of determinants and considerations to be addressed during the design process of a novel MSU program in order to balance stroke care improvements with the sustainable use of scarce resources.
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Affiliation(s)
- Johann S. Rink
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Andrej Tschalzev
- Institute for Enterprise Systems, University of Mannheim, Mannheim, Germany
| | - Christian Bartelt
- Institute for Enterprise Systems, University of Mannheim, Mannheim, Germany
| | | | - Jens Hoffmann
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Stefan O. Schoenberg
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Annika Marzina
- Department of Neurology, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Vesile Sandikci
- Department of Neurology, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Carla Wiegand
- Department of Neurology, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Carolin Hoyer
- Department of Neurology, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, Medical Faculty Mannheim, Mannheim University Medical Centre, Heidelberg University, Mannheim, Germany
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Zachrison KS, Nielsen VM, de la Ossa NP, Madsen TE, Cash RE, Crowe RP, Odom EC, Jauch EC, Adeoye OM, Richards CT. Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care. Stroke 2023; 54:1138-1147. [PMID: 36444720 PMCID: PMC11050637 DOI: 10.1161/strokeaha.122.039586] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Natalia Perez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain and Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (N.P.d.l.O)
| | - Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (T.E.M.)
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Erika C Odom
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (E.C.O.)
| | - Edward C Jauch
- Department of Research, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC (E.C.J.)
| | - Opeolu M Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO (O.M.A.)
| | - Christopher T Richards
- Division of EMS, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH (C.T.R.)
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Wang X, Carcel C, Woodward M. Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales. Med J Aust 2023; 218:96. [PMID: 36495870 DOI: 10.5694/mja2.51809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Sydney, NSW
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Kilkenny M, Eliakundu AL, Kim J. Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales. Med J Aust 2023; 218:96. [PMID: 36495867 PMCID: PMC10107469 DOI: 10.5694/mja2.51810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Monique Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC.,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | | | - Joosup Kim
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC
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