Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound

被引：36

作者：

Herzberg M. ^{[1
]}

Boy S. ^{[1
]}

Hölscher T. ^{[2
]}

Ertl M. ^{[1
]}

Zimmermann M. ^{[3
]}

Ittner K.-P. ^{[4
]}

Pemmerl J. ^{[5
]}

Pels H. ^{[6
]}

Bogdahn U. ^{[1
]}

Schlachetzki F. ^{[1
]}

机构：

[1] Department of Neurology, University of Regensburg, Community District Hospital, Regensburg 93053

[2] Department of Radiology and Neuroscience, University of California San Diego, San Diego, CA

[3] Department of Emergency Medicine, University Hospital Regensburg, Regensburg

[4] Department of Anesthesiology, University Hospital Regensburg, Regensburg

[5] Malteser Rettungsdienst, Regensburg

[6] Department of Neurology, Krankenhaus der Barmherzigen Brüder Regensburg, Regensburg

来源：

Critical Ultrasound Journal | 2014年 / 6卷 / 1期

关键词：

Acute stroke; Emergency medicine; Mobile health unit; Prehospital diagnostics; Transcranial neurosonography;

D O I：

10.1186/2036-7902-6-3

中图分类号：

学科分类号：

摘要：

Background: Transcranial color-coded sonography (TCCS) has proved to be a fast and reliable tool for the detection of middle cerebral artery (MCA) occlusions in a hospital setting. In this feasibility study on prehospital sonography, our aim was to investigate the accuracy of TCCS for neurovascular emergency diagnostics when performed in a prehospital setting using mobile ultrasound equipment as part of a neurological examination. Methods: Following a '911 stroke code' call, stroke neurologists experienced in TCCS rendezvoused with the paramedic team. In patients with suspected stroke, TCCS examination including ultrasound contrast agents was performed. Results were compared with neurovascular imaging (CTA, MRA) and the final discharge diagnosis from standard patient-centered stroke care. Results: We enrolled '232 stroke code' patients with follow-up data available in 102 patients with complete TCCS examination. A diagnosis of ischemic stroke was made in 73 cases; 29 patients were identified as 'stroke mimics'. MCA occlusion was diagnosed in ten patients, while internal carotid artery (ICA) occlusion/high-grade stenosis leading to reversal of anterior cerebral artery flow was diagnosed in four patients. The initial working diagnosis 'any stroke' showed a sensitivity of 94% and a specificity of 48%. 'Major MCA or ICA stroke' diagnosed by mobile ultrasound showed an overall sensitivity of 78% and specificity of 98%. Conclusions: The study demonstrates the feasibility and high diagnostic accuracy of emergency transcranial ultrasound assessment combined with neurological examinations for major ischemic stroke. Future combination with telemedical support, point-of-care analysis of blood serum markers, and probability algorithms of prehospital stroke diagnosis including ultrasound may help to speed up stroke treatment. © 2014 Herzberg et al.

引用

页码：1 / 13

页数：12

共 48 条

[1]

Rothwell P.M., Coull A.J., Silver L.E., Fairhead J.F., Giles M.F., Lovelock C.E., Redgrave J.N.E., Bull L.M., Welch S.J.V., Cuthbertson F.C., Binney L.E., Gutnikov S.A., Anslow P., Banning A.P., Mant D., Mehta Z., Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study), Lancet, 366, 9499, pp. 1773-1783, (2005)

[2]

Saver J.L., Time is brain-quantified, Stroke, 37, 1, pp. 263-266, (2005)

[3]

Hacke W., Kaste M., Bluhmki E., Brozman M., Davalos A., Guidetti D., Larrue V., Lees K.R., Medeghri Z., Machnig T., Schneider D., von Kummer R., Wahlgren N., Toni D., Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke, N Engl J Med, 359, 13, pp. 1317-1329, (2008)

[4]

Costalat V., Machi P., Lobotesis K., Maldonado I., Vendrell J.F., Riquelme C., Mourand I., Milhaud D., Heroum C., Perrigault P., Arquizan C., Bonafe A., Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: A prospective 50-patient single-center study: Timing, safety, and efficacy, Stroke, 42, 7, pp. 1929-1935, (2011)

[5]

Lichtman J.H., Watanabe E., Allen N.B., Jones S.B., Dostal J., Goldstein L.B., Hospital arrival time and intravenous t-PA use in US Academic Medical Centers, 2001-2004, Stroke, 40, 12, pp. 3845-3850, (2009)

[6]

Albers G.W., Olivot J., Intravenous alteplase for ischaemic stroke, Lancet, 369, 9558, pp. 249-250, (2007)

[7]

Evenson K.R., Foraker R.E., Morris D.L., Rosamond W.D., A comprehensive review of prehospital and in-hospital delay times in acute stroke care, Int J Stroke, 4, 3, pp. 187-199, (2009)

[8]

Meyer B.C., Telestroke evolution: From maximization to optimization, Stroke, 43, 8, pp. 2029-2030, (2012)

[9]

Puolakka T., Vayrynen T., Happola O., Soinne L., Kuisma M., Lindsberg P.J., Sequential analysis of pretreatment delays in stroke thrombolysis, Acad Emerg Med, 17, 9, pp. 965-969, (2010)

[10]

Teuschl Y., Brainin M., Stroke education: Discrepancies among factors influencing prehospital delay and stroke knowledge, Int J Stroke, 5, 3, pp. 187-208, (2010)

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