Recent studies show that the critical nature and time to treat patients threatened by stroke can be significantly reduced by the implementation of various technological practices.
A stroke is a medical condition that requires immediate attention. It is caused by decreased blood supply to the brain due to blockage of an artery, or trauma that leads to a tear in an artery. Blockages disrupt brain function and produce symptoms including migraines, difficulties in understanding speech, speaking with a slur, sudden loss of vision, numbness in the face, arm, and leg, and loss of balance while walking. If not given appropriate treatment promptly, patients can suffer irreversible brain damage and the loss of sensory and motor function.
Hospitals emergency departments (ED)have the challenging task of diagnosing and providing treatment to stroke patients within appropriate time frames. Research shows that delays are due to lack of specialised personnel to diagnose the condition and exclusion criteria that prevent early administration of treatment to patients. Also, unproportioned distribution of high-level speciality centres in the US further multiplies the problem; for example, the southern states of the US where the incidence of stroke is high happens to have the lowest density of trained stroke specialists and stroke speciality centres. Recent research indicates that a procedure called the Endovascular Treatment (ET) increases positive outcomes in patients. However, timely initial presentation to the ED before the development of permanent brain damage still must be managed efficiently to provide ET to patients.
An article published in the Journal of Neurosurgery by El Ghanem and the members of the neurosurgical team at the New Jersey Medical School looked at the different avenues by which the treatment of a stroke could be improved through modern advancements in technology and communication. They suggest that improvements to facilitate quick diagnoses and early management of stroke patients are enhanced by introducing technology in four primary areas. These areas are improving stroke symptom recognition, hastening the time in which emergency medical services arrive to the patient, shortening transport systems that take patients to a stroke speciality centre, and increasing the availability of a patient’s medical records to health professionals to hasten the treatment decision process.
One of improvement suggested by El Ghanem and colleagues was to enhance methods by which stroke recognition could be made easier. He proposed that stroke recognition could be increased by emergency respondents with the aid of a smartphone stroke-screening application. At present, the screening tool used by emergency respondents is the National Institutes of Health Stroke Scale (NIHSS), which is time-consuming when emergency respondents are faced with an emergency setting. The research team looked at the development of rapid assessment scales such as the Rapid Arterial Occlusion Evaluation (RACE), Vision, Aphasia, Neglect (VAN) Screening Tool, Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale, and others to facilitate faster evaluation. These scales have elements of the NIHSS but do not need great scoring to detect an occlusion in arteries. These assessment systems are simple and can be provided through an electronic device. They have been shown to quicken the pace of diagnosis and immediate neurologic management given to stroke patients. Also, such modalities would help in transferring the initial evaluation directly to the hospital, preparing the hospital staff to triage the patient beforehand, and have the necessary means ready for treatment. This would eliminate time wasted on re-evaluation of the patient upon arrival at the hospital.
They also discuss the potential for improving care in remote areas through the implementation of Telestroke. Telestroke is a tool that allows remote centres to connect to a high speciality stroke centre through video conferencing. It allows specialists to diagnose test specimens of patients, and refer them for ET without in-person physical examination. This modality has demonstrated an increase in the number of patients who benefited from early ET’s and were declared stroke-free. The greatest delay in the treatment of stroke patients is the pre-hospital transportation, which can be reduced by the implementation of Mobile Stroke Units (MSU) and Mobile Endovascular Teams (MET). MSUs are specialised ambulances that consist of a CT scanner, CT technologist, nurse, paramedic, point-of-care laboratory and a neurologist. A MET includes an endovascular surgery team that travels to remote hospitals to perform operations. These methods significantly reduce the pre-hospital consultation delay by bringing specialists to the patient, initiating proper diagnostic and management tools early on.
In addition, smartphone applications have been shown to reduce the communication time between first responder emergency personnel and specialists, by bringing initial examination findings and CT results directly to the phones of specialists. This decrease in communication time increases the convenience at which experts may examine images and hastens the identification of stroke, and thus ET surgery. Two of these applications are Stroke119 and Resolution MD.
Technology can increase the accessibility of specialists which improves efficiency of diagnosis and care in stroke patients. The authors urge the implementation of new hospital management protocols to increase patient recovery rates. Such technological implementations can prove to be cost effective to the health system, and its implementation may lead toward improved medical care for other equally critical conditions.
Written By: Dr. Apollina Sharma, MBBS, GradDip EXMD