Functional stroke outcomes after mobile stroke unit deployment – the revised protocol for the Berlin Prehospital Or Usual Delivery of acute stroke care (B_PROUD) part 2 study

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.

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The role of cardiologists on the stroke unit

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa160 ◽

2020 ◽

Vol 22 (Supplement_M) ◽

pp. M3-M12

Author(s):

Wolfram Doehner ◽

David Manuel Leistner ◽

Heinrich J Audebert ◽

Jan F Scheitz

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Stroke Care ◽

Cardiovascular Complications ◽

Large Artery ◽

Stroke Management ◽

Acute Stroke Care ◽

Daily Work ◽

Cardiovascular Comorbidity ◽

Treatment And Prevention

Abstract Cardiologists need a better understanding of stroke and of cardiac implications in modern stroke management. Stroke is a leading disease in terms of mortality and disability in our society. Up to half of ischaemic strokes are directly related to cardiac and large artery diseases and cardiovascular risk factors are involved in most other strokes. Moreover, in an acute stroke direct central brain signals and a consecutive autonomic/vegetative imbalance may account for severe and life-threatening cardiovascular complications. The strong cerebro-cardiac link in acute stroke has recently been addressed as the stroke-heart syndrome that requires careful cardiovascular monitoring and immediate therapeutic measures. The regular involvement of cardiologic expertise in daily work on a stroke unit is therefore of high importance and a cornerstone of up-to-date comprehensive stroke care concepts. The main targets of the cardiologists’ contribution to acute stroke care can be categorized in three main areas (i) diagnostics workup of stroke aetiology, (ii) treatment and prevention of complications, and (iii) secondary prevention and sub-acute workup of cardiovascular comorbidity. All three aspects are by themselves highly relevant to support optimal acute management and to improve the short-term and long-term outcomes of patients. In this article, an overview is provided on these main targets of cardiologists’ contribution to acute stroke management.

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Stroke Unit Development and Working Dynamics - Acute Stroke Care Program

Academic Emergency Medicine ◽

10.1197/j.aem.2006.10.010 ◽

2007 ◽

Vol 14 (4) ◽

pp. e76-e77

Author(s):

J. Awruch ◽

R. Valentini ◽

L. Lemme-Pleghos ◽

G. Janello ◽

I. Bonelli ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Care Program ◽

Stroke Care ◽

Acute Stroke Care

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Stroke Care in Pakistan

Cerebrovascular Diseases Extra ◽

10.1159/000519554 ◽

2021 ◽

pp. 118-121

Author(s):

Anjum Farooq ◽

Narayanaswamy Venketasubramanian ◽

Mohammad Wasay

Keyword(s):

Acute Stroke ◽

Plasminogen Activator ◽

Rural Areas ◽

Recombinant Tissue Plasminogen Activator ◽

Stroke Care ◽

Acute Stroke Care ◽

Stroke Units ◽

Stroke Outcomes ◽

Tissue Plasminogen ◽

Urban And Rural Areas

Increasing incidence of stroke and lack of infrastructure in both urban and rural areas needs immediate attention in Pakistan. There is a high proportion of young stroke with poor stroke outcomes. Acute stroke care is scarce in Pakistan due to the small number of neurologists (1 neurologist per 1 million population), few stroke units, and limited availability of alteplase (recombinant tissue plasminogen activator) in the country.

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Abstract 115: Current Status of Acute Stroke Management in Korea: A Nationwide Report Based on 19,608 Patients Treated in 216 Hospitals

Stroke ◽

10.1161/str.51.suppl_1.115 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jun Yup Kim ◽

Keon-Joo Lee ◽

Jihoon Kang ◽

Beom Joon Kim ◽

Seong-Eun Kim ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

National Level ◽

Stroke Care ◽

Current Status ◽

Endovascular Coiling ◽

Stroke Management ◽

Acute Stroke Care ◽

Survey Period ◽

Stroke Units

Introduction: There have been few reports on status of acute stroke management at a national level worldwide, and none in Korea. This study is aimed to describe the current status and disparities of acute stroke management in Korea. Methods: Data from 5th (2013) and 6th (2014) national surveys for assessing quality of acute stroke care were used. Patients with principal diagnosis codes indicating subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS), who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more stroke cases during the each 3-month survey period were selected. Results: A total of 19,608 stroke cases (age, 67.7±13.5years; female, 45%; IS, 76%; ICH, 15%; SAH, 9%) treated in 216 hospitals were analyzed. Thirty-one percent of hospitals had stroke units and 41% of stroke cases were treated at hospitals without stroke units. In IS, IV thrombolysis (IVT) and endovascular treatment (EVT) rates were 10.7% and 3.6%, respectively. Thirty-nine percent of IVT and fifty-two percent of EVT cases were performed in hospitals with annual volume of <25 IVT and <15 EVT. Centralization of EVT showed disparities by region (Figure). Carotid endarterectomy, carotid artery stenting, decompressive, bypass surgery was conducted in 0.2%, 1.4%, 1.0%, 0.2% of IS cases; decompressive surgery was done in 28.1% of ICH cases; surgical clipping, endovascular coiling was done in 17.2%, 14.3% of SAH cases, respectively. There were noticeable regional disparities in various interventions, use of ambulance, arrival time and provision of stroke unit service. Conclusions: This study is the first report on the status of acute stroke care in Korea on a national level. Large number of recanalization therapies were performed in low-volume-hospitals. Expansion of stroke unit service, stroke center certification or accreditation, and connections between stroke centers and EMS are highly recommended.

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Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services

BMJ Open ◽

10.1136/bmjopen-2018-025366 ◽

2019 ◽

Vol 9 (11) ◽

pp. e025366 ◽

Cited By ~ 1

Author(s):

Mariya Melnychuk ◽

Stephen Morris ◽

Georgia Black ◽

Angus I G Ramsay ◽

Jeannie Eng ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Performance Standards ◽

Stroke Care ◽

Acute Stroke Care ◽

P Values ◽

Stroke Units ◽

Hyperacute Stroke ◽

Time Of Admission

ObjectiveTo investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England.DesignProspective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme.SettingAcute stroke services in London hyperacute stroke units and the rest of England.Participants68 239 patients with a primary diagnosis of stroke admitted between January and December 2014.InterventionsHub-and-spoke model for care of suspected acute stroke patients in London with performance standards designed to deliver uniform access to high-quality hyperacute stroke unit care across the week.Main outcome measures16 indicators of quality of acute stroke care, mortality at 3 days after admission to the hospital, disability at the end of the inpatient spell, length of stay.ResultsThere was no variation in quality of care by day and time of admission to the hospital across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor was there variation in 3-day mortality or disability at hospital discharge (all p values>0.05). Other quality of care measures significantly varied by day and time of admission across the week in London (all p values<0.01). In the rest of England there was variation in all measures by day and time of admission across the week (all p values<0.01), except for mortality at 3 days (p value>0.05).ConclusionsThe London hyperacute stroke unit model achieved performance standards for ‘front door’ stroke care across the week. The same benefits were not achieved by other models of care in the rest of England. There was no weekend effect for mortality in London or the rest of the England. Other aspects of care were not constant across the week in London hyperacute stroke units, indicating some performance standards were perceived to be more important than others.

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Break in the Stroke Chain of Survival due to COVID-19

Stroke ◽

10.1161/strokeaha.120.030106 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2307-2314 ◽

Cited By ~ 30

Author(s):

Joan Montaner ◽

Ana Barragán-Prieto ◽

Soledad Pérez-Sánchez ◽

Irene Escudero-Martínez ◽

Francisco Moniche ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Descriptive Analysis ◽

Stroke Care ◽

Reperfusion Therapy ◽

Time Of Arrival ◽

Acute Stroke Care ◽

Before And After ◽

Chain Of Survival ◽

The Impact

Background and Purpose: Emergency measures to treat patients with coronavirus disease 2019 (COVID-19) and contain the outbreak is the main priority in each of our hospitals; however, these measures are likely to result in collateral damage among patients with other acute diseases. Here, we investigate whether the COVID-19 pandemic affects acute stroke care through interruptions in the stroke chain of survival. Methods: A descriptive analysis of acute stroke care activity before and after the COVID-19 outbreak is given for a stroke network in southern Europe. To quantify the impact of the pandemic, the number of stroke code activations, ambulance transfers, consultations through telestroke, stroke unit admissions, and reperfusion therapy times and rates are described in temporal relationship with the rising number of COVID-19 cases in the region. Results: Following confinement of the population, our stroke unit activity decreased sharply, with a 25% reduction in admitted cases (mean number of 58 cases every 15 days in previous months to 44 cases in the 15 days after the outbreak, P <0.001). Consultations to the telestroke network declined from 25 every 15 days before the outbreak to 7 after the outbreak ( P <0.001). The increasing trend in the prehospital diagnosis of stroke activated by 911 calls stopped abruptly in the region, regressing to 2019 levels. The mean number of stroke codes dispatched to hospitals decreased (78% versus 57%, P <0.001). Time of arrival from symptoms onset to stroke units was delayed >30 minutes, reperfusion therapy cases fell, and door-to-needle time started 16 minutes later than usual. Conclusions: The COVID-19 pandemic is disruptive for acute stroke pathways. Bottlenecks in the access and delivery of patients to our secured stroke centers are among the main challenges. It is critical to encourage patients to continue seeking emergency care if experiencing acute stroke symptoms and to ensure that emergency professionals continue to use stroke code activation and telestroke networks.

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Development of an acute stroke care pathway in a hospital with stroke unit

Neurología (English Edition) ◽

10.1016/s2173-5808(10)70004-3 ◽

2010 ◽

Vol 25 (1) ◽

pp. 17-26 ◽

Cited By ~ 1

Author(s):

P. Martínez-Sánchez ◽

B. Fuentes ◽

J. Medina-Báez ◽

M. Grande ◽

C. Llorente ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Care Pathway ◽

Stroke Care ◽

Acute Stroke Care

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Relevance of Stroke Code, Stroke Unit and Stroke Networks in Organization of Acute Stroke Care – The Madrid Acute Stroke Care Program

Cerebrovascular Diseases ◽

10.1159/000200452 ◽

2009 ◽

Vol 27 (1) ◽

pp. 140-147 ◽

Cited By ~ 40

Author(s):

María Alonso de Leciñana-Cases ◽

Antonio Gil-Núñez ◽

Exuperio Díez-Tejedor

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

Care Program ◽

Stroke Care ◽

Acute Stroke Care

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Estimation of Stroke Outcomes Based on Time to Thrombolysis and Thrombectomy

10.20944/preprints202007.0444.v1 ◽

2020 ◽

Author(s):

Michael Allen ◽

Kerry Pearn ◽

Ken Stein ◽

Martin James

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Acute Stroke Care ◽

Stroke Outcomes ◽

Revascularization Therapy ◽

Method Model

Background & Motivation: Stroke outcomes following revascularization therapy (intravenous thrombolysis, IVT, and/or mechanical thrombectomy, MT) depend critically on time from stroke onset to treatment. Different service configurations may prioritise time to IVT or time to MT. In order to evaluate alternative acute stroke care configurations, it is necessary to estimate clinical outcomes given differing times to IVT and MT. Method: Model using an algorithm coded in Python. This is available at https://github.com/MichaelAllen1966/stroke_outcome_algorithm. Results: We demonstrate how the code may be used to estimate clinical outcomes given varying times to IVT and MT. Conclusion: Python code has been developed and shared to enable estimation of clinical outcome given times to IVT and MT. Here we share pseudocode and links to full Python code.

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