Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Research, Norwegian Air Ambulance Foundation, Norway.
Eur Stroke J. 2024 Dec;9(4):1016-1024. doi: 10.1177/23969873241252564. Epub 2024 May 16.
The optimal pathway for ultra-early diagnostics and treatment in patients with acute stroke remains uncertain. The aim of this study was to investigate how three different methods of simulated, rural prehospital computed tomography (CT) affected the time to prehospital treatment decision in acute stroke.
In this pragmatic, simulation, pilot study of prehospital CT we investigated a conventional ambulance with transport to a standard care rural stationary CT machine managed by paramedics, a Mobile Stroke Unit (MSU), and a helicopter with a simulated CT machine. Each modality completed 20 real-life dispatches combined with simulation of predetermined animated patient cases with acute stroke symptoms and CT images. The primary endpoint of the study was the time from alarm to treatment decision.
Median time from alarm to the treatment decision differed significantly between the three groups ( = 0.0005), with 38 min for rural CT, 33 min for the MSU, and 30 min for the helicopter. There was no difference in time when comparing rural CT with MSU, nor when comparing the MSU with the helicopter. There was a difference in time to treatment decision between the rural CT and the helicopter ( < 0.0001). The helicopter had significantly lower estimated time from treatment decision to hospital ( = 0.001).
DISSCUSSION/CONCLUSION: Prehospital CT can be organized in several ways depending on geography, resources and need. Further research on paramedic run rural CT, MSU in rural areas, and helicopter CT is needed to find the optimal strategy.
急性脑卒中患者的超早期诊断和治疗的最佳途径仍不确定。本研究旨在探讨三种不同的模拟农村院前 CT 方法如何影响急性脑卒中的院前治疗决策时间。
在这项关于院前 CT 的实用模拟试验研究中,我们研究了常规救护车,将患者转运至由护理人员管理的标准农村固定 CT 机、移动脑卒中单元(MSU)和配备模拟 CT 机的直升机。每种模式都完成了 20 次真实调度,并结合了急性脑卒中症状和 CT 图像的预定动画患者病例的模拟。本研究的主要终点是从报警到治疗决策的时间。
从报警到治疗决策的时间中位数在三组之间有显著差异( = 0.0005),农村 CT 为 38 分钟,MSU 为 33 分钟,直升机为 30 分钟。农村 CT 与 MSU 之间、MSU 与直升机之间的时间无差异。农村 CT 与直升机之间的治疗决策时间有差异( < 0.0001)。直升机从治疗决策到医院的估计时间明显更短( = 0.001)。
讨论/结论:根据地理位置、资源和需求,可采用多种方式组织院前 CT。需要进一步研究农村由护理人员运行的 CT、农村地区的 MSU 和直升机 CT,以找到最佳策略。