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  • Mobile stroke unit triage of patients with a suspected stroke: a novel solution to reducing suspected stroke admissions in busy emergency departments

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Diagnostics
Original article
Mobile stroke unit triage of patients with a suspected stroke: a novel solution to reducing suspected stroke admissions in busy emergency departments
  1. Ashfaq Shuaib1,
  2. Shy Amlani2,
  3. Hayrapet Kalashyan1,
  4. Laurel Morrison2,
  5. Khurshid Khan1,
  6. Glen Jickling1,
  7. Brian Buck1,
  8. Kenneth Butcher1,
  9. Maher Saqqur1,
  10. Thomas Jeerakathil1
  1. 1 Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Clinical Neuroscience, Alberta Health Services, Edmonton, Alberta, Canada
  1. Correspondence to Professor Ashfaq Shuaib, Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada; ashfaq.shuaib{at}ualberta.ca

Abstract

Background Evaluation of patients with a suspected stroke is one of the most common neurological emergencies requiring rapid, comprehensive assessment by the stroke service to determine patient eligibility for timely reperfusion therapies. Prehospital evaluation may help to improve patient selection and reduce avoidable admissions to overcapacity emergency departments.

Methods and results We report on our early experience of prehospital triage of patients with a suspected stroke using a mobile stroke unit (MSU) equipped with CT scanner in rural Alberta. During the initial 4 months of operation, 28 patients were evaluated by the team in the MSU. Eight patients were within the time window of thrombolysis and were treated with intravenous tissue plasminogen activator in the MSU. No patients suffered haemorrhage or any other complications. Fourteen patients with multiple aetiologies (stroke mimics 6, transient ischaemic attacks 2, subacute stroke outside thrombolysis window 2, intracranial haemorrhage 3 and cerebral contusion 1) were assessed in the field and transferred to the tertiary hospital. Six patients after assessment and imaging were repatriated back to the local hospital as they were deemed stroke mimics or were outside of the reperfusion window.

Conclusions The MSU offers a novel approach to performing timely evaluation and treatment of patients with a suspected stroke in rural settings and may help reduce admissions to overcapacity tertiary care facilities.

  • suspected stroke patient triage
  • stroke ambulance
  • acute stroke

https://doi.org/10.1136/bmjinnov-2017-000240

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    Footnotes

    • Contributors AS designed the study and wrote the manuscript. SA developed the protocols and reviewed the manuscript. HK developed the protocols, collected patient data and reviewed the manuscript. LM developed the protocols and reviewed the manuscript. KK, GJ, BB, KB and MS helped with recruitment of patients and manuscript review. TJ was the lead of the project and provided critical review of the manuscript.

    • Funding The University Hospital Foundation is the major funding source for the Alberta Mobile Stroke project. We thank the QUICR Project and AIHS, the Canadian Stroke Network for contributing additional funding, and Alberta Health Services for substantial in-kind contributions and support.

    • Competing interests None declared.

    • Ethics approval University of Alberta IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This article has been corrected since it was published Online First. The Funding statement has been amended.