Emergency Treatment Of Acute Stroke Research Articles

Factors associated with hospital arrival time of acute stroke patients in rural India

Abstract Funding Acknowledgements Type of funding sources: None. Background Delays in the treatment of acute stroke leads to unfavorable prognosis. Shortening the delay time in the health care of these patients is essential in order to reduce the morbidity and mortality rates of this disease. Eligibility for acute stroke interventions depends on the time from symptom onset to hospital arrival. The socio-cultural profile in rural India is different from that in urban India. Lot of people in rural India prefer living in joint families, general level of education and awareness is low and they opt for alternative modalities of treatment for stoke. There is lack of adequate and fast transport facilities that worsen the scenario. Delay in arrival of acute stroke cases may be caused by organizational, educational, socioeconomic and demographic factors. Purpose This study was conducted to understand the factors associated with hospital arrival time of acute stroke patients in Rural India. Materials and Methods Hospital data of 27 acute stroke patients admitted to our clinic from January 2019 to December 2019 was retrospectively studied. Stroke was defined, according to the WHO definition, as 'rapidly developing clinical sign of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than of vascular origin'. Chi square test and Mann Whitney U tests were used to analyze the data. Results Only 8 (29.62%) patients arrived within 3 hours of stroke onset whereas 3 (11.11%) patients arrived after 12 hours. Mean and standard deviation of hospital arrival time in minutes for patients < 50 years was 125±116, for 51-60 years was 279±127, for 61-70 years was 379±191 and for >70 years was 1127±716.Younger patients reported significantly earlier than older ones (p <0.001). Males reported earlier than females (p: 0.032). Patients with stroke onset in the night time arrived significantly late compared to stroke onset in the day time (p:0.001). Prior ayurvedic treatment delayed hospital arrival (p <0.001). Conclusions A nationwide public awareness campaign is needed to improve the public awareness of stroke and importance of timely treatment when acute stroke symptoms are suspected. Lot of patients in rural India still delay emergency treatment of acute stroke due to preference to ayurvedic remedies which should be strongly discouraged. Gender and age bias need to be further studied and strategies to reduce the bias should be considered. This study shows that there is substantial room for reducing the time from symptom onset to hospital arrival in acute stroke. Strategies to improve stroke awareness and referral protocols together with the use of tele-medicine and mobile stroke unit should be considered to reduce the hospital arrival time.

Difficulties and Countermeasures in Hospital Emergency Management for Fast-Lane Treatment of Acute Stroke During the COVID-19 Epidemic Prevention and Control.

Background: Coronavirus disease 2019 (COVID-19) has a long incubation period and a high degree of infectivity. Patients may not show specific signs or symptoms of upper respiratory tract infection, and the age of onset is similar to that of stroke. Furthermore, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. Providing emergency treatment for acute stroke in accordance with the strict epidemic control measures is currently one of the main challenges, as acute stroke is rapid onset and a major cause of death and disability globally. We aimed to evaluate the emergency treatment system for acute stroke during the epidemic control period to provide a reference and basis for informing government and medical institutions on improving patient treatment rates during this period.Methods: Difficulties faced in providing emergency treatment for stroke during an epidemic were investigated and combined with medical educational resources and clinical management experiences to construct an emergency treatment framework for acute stroke during the epidemic.Findings: Currently, emergency treatment measures for acute stroke during the epidemic control period are limited because the main focus is on identifying COVID-19 comorbidities during the critical period. Establishing standards for patients in the neurological outpatient consultation rooms and emergency observation and resuscitation zones; implementing a fast-lane system for the emergency treatment of patients with acute stroke, and strengthening ward management and medicine popularization, can improve the treatment efficiency for stroke patients during the epidemic and provide a reference for peers in clinical practice.Interpretation: Emergency treatment for acute stroke during COVID-19 epidemic control period requires a joint promotion of clinical, popularization, and teaching resources.

Head down tilt 15° in experimental intracerebral hemorrhage: a randomized noninferiority safety trial.

Head down tilt 15° (HDT15°), applied before recanalization, increases collateral flow and improves outcome in experimental ischemic stroke. For its simplicity and low cost, HDT15° holds considerable potential to be developed as an emergency treatment of acute stroke in the prehospital setting, where hemorrhagic stroke is the major mimic of ischemic stroke. In this study, we assessed safety of HDT15° in the acute phase of experimental intracerebral hemorrhage. Intracerebral hemorrhage was produced by stereotaxic injection of collagenase in Wistar rats. A randomized noninferiority trial design was used to assign rats to HDT15° or flat position (n=64). HDT15° was applied for 1h during the time window of hematoma expansion. The primary outcome was hematoma volume at 24h. Secondary outcomes were mass effect, mortality, and functional deficit in the main study and acute changes of intracranial pressure, hematoma growth, and cardiorespiratory parameters in separate sets of randomized animals (n=32). HDT15° achieved the specified criteria of noninferiority for hematoma volume at 24h. Mass effect, mortality, and functional deficit at 24h showed no difference in the two groups. HDT15° induced a mild increase in intracranial pressure with respect to the pretreatment values (+2.91±1.76mmHg). HDT15° had a neutral effect on MRI-based analysis of hematoma growth and cardiorespiratory parameters. Application of HDT15° in the hyperacute phase of experimental intracerebral hemorrhage does not worsen early outcome. Further research is needed to implement HDT15° as an emergency collateral therapeutic for acute stroke.

A systematic review of the cost-effectiveness of emergency interventions for stroke in low- and middle-income countries.

BackgroundStroke is a leading cause of death and disability globally, with an increasing incidence in low- and middle-income countries (LMICs). The successful treatment of acute stroke requires an organized, efficient and well-resourced emergency care system. However, debate exists surrounding the prioritization of stroke treatment programs given the high costs of treatment and the increased incidence of hemorrhagic stroke in LMICs. Economic data is helpful to guide evidence-based priority setting in health systems development, particularly in low-resource settings where scarcity requires careful stewardship of resources. This systematic review surveys the existing evidence surrounding the cost-effectiveness of interventions to address acute stroke in LMIC settings.MethodsThe authors conducted a PRISMA style systematic review of economic evaluations of interventions to address acute stroke in LMICs. Five databases were systematically searched for articles, which were then reviewed for inclusion.ResultsOf the 153 unique articles identified, 11 met the inclusion criteria. Four studies demonstrate the heavy economic burden on patients and households due to stroke. Two studies estimate that preventive measures are more cost-effective than acute treatments. Four studies directly examine the cost-effectiveness of thrombolysis and thrombectomy in three middle-income countries (Iran, China, and Brazil) with results ranging from roughly $2578 to $34,052 (2019 USD) per quality adjusted life-year saved. These results are similar to the cost-effectiveness ratios estimated in high-income settings. Finally, one study examined a care bundle that included acute treatment elements.ConclusionsThe findings reinforce the need for additional research support informed decision-making. The available evidence suggests that preventive measures should be prioritized over emergency treatment for acute stroke, particularly in settings of resource scarcity. Cost-effectiveness ratios do not compare favorably to estimates for other emergency care interventions in LMICs, such as basic emergency care training, implementation of triage systems, and basic trauma care. Cost-effectiveness is also likely to vary depending on local epidemiology. Overall, decision-makers should balance the economic evidence alongside social, political and cultural priorities when making resource allocation choices.

Reducing post-stroke disability in diabetic patients

Stroke is the main cause of acquired disability in adults and is particularly frequent in diabetic patients. Recent data have shown that stroke-related disability may be substantially reduced by emergency treatment of acute stroke in dedicated stroke units and by rapid management of transient ischaemic attack (TIA) and minor strokes, which remain too often neglected. Simple clinical scores have been developed to improve pre-hospital diagnosis of acute stroke and risk estimation in patients with TIA or minor stroke. They are simple enough to be adapted in patient education programs and stroke education may reduce stroke-related disability by increasing the number of patients immediately seeking appropriate stroke care. Immediate access to diffusion MRI and intra-cranial MR angiography further improves diagnosis and risk estimation in TIA and minor stroke. Urgent investigations should also include systematic non-invasive and high quality detection of severe carotid stenosis, which requires rapid endarterectomy, and of permanent or paroxysmal atrial fibrillation (AF), which requires oral anticoagulation.