Abstract P424: Hemorrhage Enlargement in the First Two Hours: A Mobile Stroke Unit Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ritvij Bowry ◽  
Stephanie Parker ◽  
Patti Bratina ◽  
Kenny Phan ◽  
Noopur Singh ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Stroke Unit ◽  
High Reliability ◽  
Measurement Techniques ◽  
Intraclass Correlation ◽  
Ct Scans ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Enlargement ◽  
Mobile Stroke Unit ◽  
Repeat Imaging

Objective: Hematoma enlargement (HE) occurs after spontaneous intracerebral hemorrhage (ICH) but no studies have evaluated the frequency of HE in first 1-2 h after symptom onset. We evaluated HE in the first 2h after onset using a mobile stroke unit (MSU). Methods: Patients with spontaneous ICH within 4.5h were evaluated on the Houston MSU between 5/2014 and 4/2020. Baseline CT scans from the MSU were compared with scans repeated within 1h [median 67min (IQR 57-82 min]. Significant HE was defined as >6 ml if baseline volume was <20 ml and 30% increase if baseline volume >20 ml. Kruskal-Wallis and Wilcoxon rank sum tests evaluated differences in baseline volumes and HE. Intraclass correlation coefficient (ICC) evaluated agreement between two ICH measurement techniques (ABC/2 vs semi-automated). Results: 163 patients had baseline CTs, of whom 60 had repeat 1h CTs (table 1). There was no difference between baseline volume and time of CT from symptom onset {<1h vs 1-2h vs >2h median (IQR) = 14 ml (6-28) vs. 16 ml (7-32) vs. 12 ml (4-24), P=0.42)}. There was also no correlation between time from onset and difference in volume between baseline and 1 h repeat imaging. However, 9/60 patients had significant HE from baseline to 1 h repeat imaging; all of these occurred in patients initially imaged within 2 h of onset (6/24 within 1h, 3/20 within 1-2h) (P=0.03) (figure 1). High reliability was seen between the two methods measuring volumes (ICC = 0.84). Conclusion: Significant HE in the next hour occurs in 25% of ICH patients imaged within the first hour after symptom onset, and 17% imaged between 1-2 hours of onset. These patients would be a target for ultra-early hemostatic intervention.

scholarly journals Mobile Stroke Unit Hits the Road in Houston

US Neurology ◽  
2015 ◽  
Vol 11 (01) ◽  
pp. 59
Author(s):  
James C Grotta ◽  
Keyword(s):  
Symptom Onset ◽  
Stroke Unit ◽  
Quality Adjusted Life Years ◽  
Stroke Treatment ◽  
The Road ◽  
Standard Management ◽  
Mobile Stroke Unit ◽  
Life Years ◽  
Tissue Plasminogen ◽  
Quality Adjusted Life

After 1 year of preparation, the nation’s first Mobile Stroke Unit (MSU) delivering acute stroke treatment with tissue plasminogen activator (tPA) in the prehospital setting was launched in mid 2014. The unit is being operated as part of a clinical trial comparing MSU management to standard management to determine how much faster patients can be treated, how much better patients do if treated in the first hour after symptom onset than if treated later, if the physician on board the MSU can be replaced by a remote physician via telemedicine, and the costs and quality-adjusted life years saved by the MSU approach. We are treating on average over two patients per week with intravenous tPA, with more than 30 % treated within the first hour of symptom onset.

Abstract TP362: Early Hematoma Enlargement in Intracerebral Hemorrhage Patients on the Mobile Stroke Unit

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Judy Jia ◽  
Ritvij Bowry ◽  
Chunyan Cai ◽  
Stephanie Parker ◽  
James Grotta
Keyword(s):  
Intracerebral Hemorrhage ◽  
Stroke Unit ◽  
Small Sample Size ◽  
Small Sample ◽  
Hematoma Enlargement ◽  
Mobile Stroke Unit ◽  
Hospital Patients ◽  
Group A ◽  
Group 3

Introduction: Hematoma enlargement (HE) in intracerebral hemorrhage (ICH) possibly occurs soon after onset but is not captured due to delays in imaging. The Mobile Stroke Unit (MSU) can identify ICH patients in the prehospital setting and can increase our understanding of ICH patients in the first hour of onset. Methods: This was a prospective, observational study to examine patients within 4 hours of symptom onset and early HE in ICH due to hypertension and/or coagulopathies. A baseline head CT (HCT) was performed on the MSU, followed by a 1-hour HCT at the destination hospital. Patients during MSU control weeks were included but not required to have a 1-hour HCT. Blood pressure was treated to a systolic goal of <150mmHg. Hematoma volume (HV) was measured by the ABC/2 method. HE was defined as an increase in HV by >6cc or >30% between scans. Patients were categorized by time to first HCT (≤61min, 62-120min, and 120-270min). Overall HE for each group was calculated using the scan nearest to 24 hours. HE on the 1-hour HCT was calculated for the ≤61min group and for the all patients collectively. The additional HE between the 1-hour HCT and scan nearest to 24 hours was also captured. Results: Twenty-three patients (19 MSU) were included. Four of 8 (50%) patients in the ≤61min group, 3/7 (42.9%) in the 62-120min group, and 3/8 (37.5%) in the 120-270min group had HE in the first 24hrs, p=1.0 (Figure 1). Among the patients who had a 1-hour HCT, the incidence of HE over the first hour in the ≤61min group was 0.4 (2/5) and 0.36 (4/11) for all 3 groups. Additional HE beyond the 1-hour HCT occurred in only 1/9 patients (no follow up scan in 2 patients). Conclusion: There was a high incidence of HE 1 to 2 hours after onset in ICH patients. This period may be an optimal window for treatment. Limitations include a small sample size and confounding due to early intervention in the MSU group. A larger study is currently ongoing.

scholarly journals Interpretation of Brain CT Scans in the Field by Critical Care Physicians in a Mobile Stroke Unit

2017 ◽  
Vol 28 (1) ◽  
pp. 106-111 ◽  
Author(s):  
Maren Ranhoff Hov ◽  
Erik Zakariassen ◽  
Thomas Lindner ◽  
Terje Nome ◽  
Kristi G. Bache ◽  
...  
Keyword(s):  
Critical Care ◽  
Stroke Unit ◽  
Ct Scans ◽  
Brain Ct ◽  
Mobile Stroke Unit

scholarly journals Reliability of Field Assessment Stroke Triage for Emergency Destination Scale Use by Paramedics: Mobile Stroke Unit First-Year Experience

Stroke ◽  
2021 ◽  
Author(s):  
Nirav R. Bhatt ◽  
Michael R. Frankel ◽  
Raul G. Nogueira ◽  
Carol Fleming ◽  
Nicolas A. Bianchi ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Intraclass Correlation ◽  
Final Diagnosis ◽  
Prehospital Setting ◽  
First Year Experience ◽  
First Year ◽  
Vessel Occlusion ◽  
Field Assessment ◽  
Mobile Stroke Unit ◽  
Ischemic Attack

Background and Purpose: Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale is a helpful tool to triage patients with stroke in the field. However, data on its reliability in the prehospital setting are lacking. We aim to test the reliability of FAST-ED scale when used by paramedics in a mobile stroke unit covering a metropolitan area. Methods: As part of standard operating mobile stroke unit procedures, paramedics initially evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic upon patient contact (in-person) and then independently by a vascular neurologist (VN) immediately after paramedic evaluation (remotely/telemedicine). This allowed testing of the interrater agreement of the FAST-ED scoring performance between on-site prehospital providers and remotely located VN. Results: Of a total of 238 patients transported in the first 15 months of the mobile stroke unit’s activity, 173 were included in this study. Median age was 63 (interquartile range, 55.5–75) years and 52.6% were females. A final diagnosis of ischemic stroke was made in 71 (41%), transient ischemic attack in 26 (15%), intracranial hemorrhage in 15 (9%), whereas 61 (35%) patients were stroke mimics. The FAST-ED scores matched perfectly among paramedics and VN in 97 (56%) instances, while there was 0 to 1-point difference in 158 (91.3%), 0 to 2-point difference in 171 (98.8%), and 3 or more point difference in 2 (1.1%) patients. The intraclass correlation between VN and paramedic FAST-ED scores showed excellent reliability, intraclass correlation coefficient 0.94 (95% CI, 0.92–0.96; P <0.001). When VN recorded FAST-ED score ≥3, paramedics also scored FAST-ED≥3 in majority of instances (63/71 patients; 87.5%). A large vessel occlusion was identified in 16 (9.2%) patients; 13 occlusions were identified with a FAST-ED≥3 while 3 were missed. All of the latter patients had National Institutes of Health Stroke Scale score ≤5. Conclusions: We demonstrate excellent reliability of FAST-ED scale performed by paramedics when compared with VN, indicating that it can be accurately performed by paramedics in the prehospital setting.

010 The melbourne mobile stroke unit substantially improves thrombolysis times and pre-hospital triage

2018 ◽  
Vol 89 (6) ◽  
pp. A5.2-A5
Author(s):  
Henry Zhao ◽  
Skye Coote ◽  
Lauren Pesavento ◽  
Francesca Langenberg ◽  
Patricia Desmond ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Stroke Unit ◽  
Life Support ◽  
Hospital Treatment ◽  
Future Research ◽  
Stroke Patients ◽  
Time Saving ◽  
Royal Melbourne Hospital ◽  
Stroke Treatment ◽  
Mobile Stroke Unit

IntroductionThe Melbourne mobile stroke unit (MSU) project is the first Australian pre-hospital stroke service that delivers on-scene imaging, treatment and triage. The MSU vehicle consists of a Mercedes Sprinter-5 chassis with on-board CereTom 8-slice portable CT scanner and telemedicine capabilities. On-board crew consists of a neurologist/telemedicine, nurse, radiographer and two paramedics (advanced-life-support and mobile-intensive-care). The MSU service is co-dispatched within 20 km of Royal Melbourne Hospital. We describe the service activity since project launch.MethodsData are sourced from the Melbourne MSU registry, an ongoing prospectively collected database of all MSU dispatched cases since November 2017.ResultsIn the first 50 operational days, there were a total of n=255 dispatches (5.1/day), of which 47% of patients received on-scene attendance. On-scene CT was performed on 52% of all attendances. Of n=29 suspected ischaemic stroke cases<6 hours of symptom onset (24% of attended), n=10 (34%) received pre-hospital thrombolysis and n=6 (21%) were directed for endovascular thrombectomy. 30% of patients were thrombolysed within 90 min of symptom onset. A total of n=7 (14% of all stroke) patients were recommended to bypass the closest hospital to a specialist centre for endovascular, neurosurgical or other services. The median scene-to-thrombolysis time of 36.5 min was substantially better than Australian in-hospital averages and represented an estimated 30–45 min time saving compared to in-hospital treatment.DiscussionThe Melbourne MSU project shows that pre-hospital diagnosis and treatment of stroke patients is feasible and associated with substantial time saving in providing acute stroke treatment and triage. Future research will focus on optimising MSU dispatch and cost-effectiveness analysis.

4G versus 3G-enabled telemedicine in prehospital acute stroke care

2019 ◽  
Vol 14 (6) ◽  
pp. 620-629 ◽  
Author(s):  
B Winter ◽  
M Wendt ◽  
C Waldschmidt ◽  
M Rozanski ◽  
A Kunz ◽  
...  
Keyword(s):  
Mobile Communications ◽  
Stroke Unit ◽  
Intraclass Correlation ◽  
Visual Quality ◽  
Treatment Decisions ◽  
Current Evidence ◽  
Stroke Work ◽  
Stroke Units ◽  
Mobile Stroke Unit

Background Time to reperfusion treatment is closely related to outcome in ischemic stroke. Prehospital stroke work-up in CT-equipped mobile stroke units is effective in reducing time to thrombolytic treatment. Current evidence predominantly comes from mobile stroke units staffed with neurologists but telemedicine-guided management may be acceptable for providing neurological expertise in ambulances. With unsatisfactory experiences in third-generation (3G)-based approaches, fourth-generation (4G) networks may provide adequate audio-visual quality but systematic comparisons of technological parameters and decision-making are lacking. Methods Trained actors presented stroke symptoms and paramedics assisted the remotely guided extended National Institutes of Health Stroke Scale (eNIHSS) assessment on the mobile stroke unit in Berlin, Germany. We compared technical parameters of 4G and 3G connections, assessed audio-visual quality of examination, and analyzed reliability of neurological assessment and treatment decisions made by the remote neurologist versus the mobile stroke unit neurologist. Results 4G and 3G connections were evaluated in 40 scenarios each. Connectivity was not available in 17% of 4G- and 15% of 3G-attempts with 6% simultaneous unavailability of both networks. The remote examiners graded audio and video quality in 4G better than in 3G with slightly shorter assessment duration in 4G (mean: 9 (SD:5) vs. mean 11 (SD:3) min, p = 0.10). Reliability of the eNIHSS sum scores was high with intraclass correlation coefficients of 0.99 (95% CI: 0.987–1.00) for 4G and 0.98 (95% CI: 0.96–0.99) for 3G. None of the remote treatment decisions differed from onsite decisions. Conclusions 4G mobile communications provided higher quality of video-examination and allowed reliable remote assessment of stroke symptoms but coverage was still incomplete in both networks.

scholarly journals Establishing the First Mobile Stroke Unit in the United States

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1384-1391 ◽  
Author(s):  
Stephanie A. Parker ◽  
Ritvij Bowry ◽  
Tzu-Ching Wu ◽  
Elizabeth A. Noser ◽  
Kamilah Jackson ◽  
...  
Keyword(s):  
United States ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
Stroke Unit ◽  
Radiation Safety ◽  
The United States ◽  
Base Station ◽  
Medical Services ◽  
Emergency Medical ◽  
Mobile Stroke Unit

Background and Purpose— Recently, the Mobile Stroke Unit (MSU) concept was introduced in Germany demonstrating prehospital treatment of more patients within the first hour of symptom onset. However, the details and complexities of establishing such a program in the United States are unknown. We describe the steps involved in setting up the first MSU in the United States. Methods— Implementation included establishing leadership, fund-raising, purchase and build-out, knitting a collaborative consortium of community stakeholders, writing protocols to ensure accountability, radiation safety, purchasing supplies, licensing, insurance, establishing a base station, developing a communication plan with city Emergency Medical Services, Emergency Medical Service training, staffing, and designing a research protocol. Results— The MSU was introduced after ≈1 year of preparation. Major obstacles to establishing the MSU were primarily obtaining funding, licensure, documenting radiation safety protocols, and establishing a smooth communication system with Emergency Medical Services. During an 8 week run-in phase, ≈2 patients were treated with recombinant tissue-type plasminogen activator per week, one-third within 60 minutes of symptom onset, with no complications. A randomized study to determine clinical outcomes, telemedicine reliability and accuracy, and cost effectiveness was formulated and has begun. Conclusion— The first MSU in the United States has been introduced in Houston, TX. The steps needed to accomplish this are described.

scholarly journals Is there a relationship between the overhead press and split jerk maximum performance? Influence of sex

2021 ◽  
pp. 174795412110204
Author(s):  
Marcos A Soriano ◽  
G Gregory Haff ◽  
Paul Comfort ◽  
Francisco J Amaro-Gahete ◽  
Antonio Torres-González ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Body Mass ◽  
Upper Limb ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Training Experience ◽  
Maximum Performance ◽  
Repetition Maximum ◽  
Intraclass Correlation Coefficients

The aims of this study were to (I) determine the differences and relationship between the overhead press and split jerk performance in athletes involved in weightlifting training, and (II) explore the magnitude of these differences in one-repetition maximum (1RM) performances between sexes. Sixty-one men (age: 30.4 ± 6.7 years; height: 1.8 ± 0.5 m; body mass 82.5 ± 8.5 kg; weightlifting training experience: 3.7 ± 3.5 yrs) and 21 women (age: 29.5 ± 5.2 yrs; height: 1.7 ± 0.5 m; body mass: 62.6 ± 5.7 kg; weightlifting training experience: 3.0 ± 1.5 yrs) participated. The 1RM performance of the overhead press and split jerk were assessed for all participants, with the overhead press assessed on two occasions to determine between-session reliability. The intraclass correlation coefficients (ICC) and 95% confidence intervals showed a high reliability for the overhead press ICC = 0.98 (0.97 – 0.99). A very strong correlation and significant differences were found between the overhead press and split jerk 1RM performances for all participants (r = 0.90 [0.93 – 0.85], 60.2 ± 18.3 kg, 95.7 ± 29.3 kg, p ≤ 0.001). Men demonstrated stronger correlations between the overhead press and split jerk 1RM performances (r = 0.83 [0.73-0.90], p ≤ 0.001) compared with women (r = 0.56 [0.17-0.80], p = 0.008). These results provide evidence that 1RM performance of the overhead press and split jerk performance are highly related, highlighting the importance of upper-limb strength in the split jerk maximum performance.

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 116-123
Author(s):  
Mathew Cherian ◽  
Pankaj Mehta ◽  
Shriram Varadharajan ◽  
Santosh Poyyamozhi ◽  
Elango Swamiappan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Review ◽  
Stroke Unit ◽  
Care Pathway ◽  
Clinical Care ◽  
Stroke Care ◽  
First Year ◽  
Proof Of Concept ◽  
Mobile Stroke Unit ◽  
Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

Validation of a Knowledge Transfer Tool for the Knee Inflammation MRI Scoring System for Bone Marrow Lesions According to the OMERACT Filter: Data from the Osteoarthritis Initiative

2017 ◽  
Vol 44 (11) ◽  
pp. 1718-1722 ◽  
Author(s):  
Jacob L. Jaremko ◽  
Omar Azmat ◽  
Robert G. Lambert ◽  
Paul Bird ◽  
Ida K. Haugen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Scoring System ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Average Score ◽  
Therapeutic Trial ◽  
Web Based ◽  
Bone Marrow Lesions ◽  
Smallest Detectable Change ◽  
Osteoarthritis Initiative

Objective.To assess feasibility and reliability of scoring bone marrow lesions (BML) on knee magnetic resonance imaging (MRI) in osteoarthritis using the Outcome Measures in Rheumatology Knee Inflammation MRI Scoring System (KIMRISS), with a Web-based interface and online training with real-time iterative calibration.Methods.Six readers new to the KIMRISS (3 radiologists, 3 rheumatologists) scored sagittal T2-weighted fat-saturated MRI in 20 subjects randomly selected from the Osteoarthritis Initiative data, at baseline and 1-year followup. In the KIMRISS, the reader moves a transparent overlay grid within a Web-based interface to fit bones, then clicks or touches each region containing BML per slice, to score 1 if BML is present. Regional and total scores are automatically calculated. Outcomes include the interreader intraclass correlation coefficients (ICC) and the smallest detectable change (SDC).Results.Scoring took 3–12 min per scan and all readers rated the process as moderately to very user friendly. Despite a low BML burden (average score 2.8% of maximum possible) and small changes, interobserver reliability was moderate to high for BML status and change in the femur and tibia (ICC 0.78–0.88). Four readers also scored the patella reliably, whereas 2 readers were outliers, likely because of image artifacts. SDC of 1.5–5.6 represented 0.7% of the maximum possible score.Conclusion.We confirmed feasibility of knee BML scoring by new readers using interactive training and a Web-based touch-sensitive overlay system, finding high reliability and sensitivity to change. Further work will include adjustments to training materials regarding patellar scoring, and study in therapeutic trial datasets with higher burden of BML and larger changes.

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