Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke
Ibsen, Jørgen; Hov, Maren Ranhoff; Tokerud, Gunn Eli; Fuglum, Julia; Krogstad, Marianne Linnerud; Stugaard, Marie; Ihle-Hansen, Hege Beate; Lund, Christian; Hall, Christian
Peer reviewed, Journal article
Published version
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https://hdl.handle.net/11250/3159124Utgivelsesdato
2024Metadata
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Originalversjon
10.1177/23969873241267084Sammendrag
Background: Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The
prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for
disability-preventing thrombolytic therapy due to prolonged transport times.
Methods: Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a
computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of
patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and
a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely
controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a
primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017–2021 into
a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients
from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT
scanner (the Reference group).
Results: A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and
69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset
of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference
group (p < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median
124 min in the Rural CT group and 213 min in the Reference group, p < 0.05. The frequency of thrombolysis for ischemic
stroke did not significantly differ between the two groups.
Conclusion: Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment
by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.