Abraham Siju V, Joy Anita, Sahu Ankit Kumar, Ravindra Prithvishree, Dhar Shirshendu, Teja Ravi, Krishnan S Vimal, Liu Renyu, Rudd Anthony George, Ford Gary A
Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
The World Stroke Organization Taskforce for Prehospital Care, Geneva, Switzerland.
J Emerg Trauma Shock. 2024 Jul-Sep;17(3):129-135. doi: 10.4103/jets.jets_156_23. Epub 2024 Aug 30.
The incidence of stroke is increasing in India. Prehospital stroke care is crucial for reducing stroke morbidity and mortality, but its implementation in India faces several challenges. Limited original research exists on prehospital stroke care in India, making it essential to identify the problems in implementing effective prehospital stroke care.
A web-based survey was conducted among registered medical practitioners in India who treat acute stroke. The survey questionnaire was developed in English and included 26 questions divided into five parts: questions about the physician's practice setup/hospital in India, perception of community awareness, existing prehospital care/systems, in-hospital stroke care availability, and specific issues faced.
Eighty-three doctors in India participated in the survey (43% response rate). Most of the respondents worked in private hospitals (68%) and urban areas (76%). While 89% of hospitals had ambulance services, over 33% reported that patients had to pay for ambulance transport. Among respondents, 12% reported a community stroke care network, with infrequent prehospital procedures such as random blood glucose measurement (22%), stroke identification (15.7%), "last seen normal" documentation (14.5%), and low prehospital notification to hospitals (5%). Delays in referral from peripheral centers were reported by 73% of respondents. Most hospitals had standard operating procedures (SOPs) (84%), computed tomography (CT) (94%), magnetic resonance imaging (MRI) (85%), and offered intravenous thrombolysis (IVT) (77%). However, 24 h availability of CT was reported only by 6%, MRI by 19% and IVT by 12%. Nearly half (45%) reported treatment with thrombolysis was not covered by insurance. Mechanical thrombectomy was available in 34% of hospitals and 63% of hospitals conducted in-hospital audits for stroke patients.
The capabilities of stroke-catering hospitals in urban settings are encouraging, with many having SOPs, imaging capabilities, and thrombolysis and mechanical thrombectomy services. However, there is much room for improvement, in making the essential stroke care services financially accessible to all and available around the clock.
印度中风的发病率正在上升。院前中风护理对于降低中风的发病率和死亡率至关重要，但在印度实施面临诸多挑战。关于印度院前中风护理的原始研究有限，因此识别实施有效院前中风护理中的问题至关重要。
对印度治疗急性中风的注册执业医生进行了一项基于网络的调查。调查问卷用英文编写，包括26个问题，分为五个部分：关于医生在印度的执业机构/医院、对社区认知的看法、现有的院前护理/系统、医院内中风护理的可及性以及面临的具体问题。
印度的83名医生参与了调查（回复率为43%）。大多数受访者在私立医院工作（68%）且位于城市地区（76%）。虽然89%的医院有救护车服务，但超过33%的受访者表示患者需支付救护车运输费用。在受访者中，12%报告有社区中风护理网络，院前程序执行频率较低，如随机血糖测量（22%）、中风识别（15.7%）、“最后一次正常”记录（14.5%），且院前通知医院的比例较低（5%）。73%的受访者报告了外周中心转诊延迟的情况。大多数医院有标准操作程序（SOPs）（84%）、计算机断层扫描（CT）（94%）、磁共振成像（MRI）（85%），并提供静脉溶栓（IVT）（77%）。然而，仅6%的医院报告CT可24小时提供，19%的医院报告MRI可24小时提供，12%的医院报告IVT可24小时提供。近一半（45%）的受访者报告溶栓治疗不在保险范围内。34%的医院有机械取栓设备，63%的医院对中风患者进行院内审核。
城市地区提供中风护理的医院的能力令人鼓舞，许多医院有SOPs、成像能力以及溶栓和机械取栓服务。然而，在使所有患者都能在经济上获得基本中风护理服务并实现全天候可用方面，仍有很大的改进空间。
