43 research outputs found
Paramedic Acute Stroke Treatment Assessment (PASTA): study protocol for a randomised controlled trial
BACKGROUND: Despite evidence from clinical trials that intravenous (IV) thrombolysis is a cost-effective treatment for selected acute ischaemic stroke patients, there remain large variations in the rate of IV thrombolysis delivery between stroke services. This study is evaluating whether an enhanced care pathway delivered by paramedics (the Paramedic Acute Stroke Treatment Assessment (PASTA)) could increase the number of patients who receive IV thrombolysis treatment. METHODS: Study design: Cluster randomised trial with economic analysis and parallel process evaluation. SETTING: National Health Service ambulance services, emergency departments and hyper-acute stroke units within three geographical regions of England and Wales. Randomisation: Ambulance stations within each region are the units of randomisation. According to station allocation, paramedics based at a station deliver the PASTA pathway (intervention) or continue with standard stroke care (control). Study intervention: The PASTA pathway includes structured pre-hospital information collection, prompted pre-notification, structured handover of information in hospital and assistance with simple tasks during the initial hospital assessment. Study-trained intervention group paramedics deliver this pathway to adults within 4 h of suspected stroke onset. Study control: Standard stroke care according to national and local guidelines for the pre-hospital and hospital assessment of suspected stroke. PARTICIPANTS: Participants enrolled in the study are adults with confirmed stroke who were assessed by a study paramedic within 4 h of symptom onset. PRIMARY OUTCOME: Proportion of participants receiving IV thrombolysis. SAMPLE SIZE: 1297 participants provide 90% power to detect a 10% difference in the proportion of patients receiving IV thrombolysis. DISCUSSION: The results from this trial will determine whether an enhanced care pathway delivered by paramedics can increase thrombolysis delivery rates. TRIAL REGISTRATION: ISRCTN registry, ISRCTN12418919 . Registered on 5 November 2015
Posterior reversible encephalopathy syndrome in a complicated autoimmune background: differential diagnosis and etiological hypothesis
Uremic encephalopathy with isolated brainstem involvement revealed by magnetic resonance image: a case report
Establishment and utility assessment of posterior reversible encephalopathy syndrome early warning scoring (PEWS) scale establishment and utility assessment of PEWS scale
Posterior reversible encephalopathy syndrome with extensive cytotoxic edema after blood transfusion: a case report and literature review
Early computed tomography-based scores to predict decompressive hemicraniectomy after endovascular therapy in acute ischemic stroke
Background
Identification of patients requiring decompressive hemicraniectomy (DH) after endovascular
therapy (EVT) is crucial as clinical signs are not reliable and early DH has been shown to
improve clinical outcome. The aim of our study was to identify imaging-based scores to predict
the risk for space occupying ischemic stroke and DH.
Methods
Prospectively derived data from patients with acute large artery occlusion within the anterior
circulation and EVT was analyzed in this monocentric study. Predictive value of non-contrast
cranial computed tomography (ncCT) and cerebral blood volume (CBV) Alberta Stroke
Program Early CT score (ASPECTS) were investigated for DH using logistic regression
models and Receiver Operating Characteristic Curve analysis.
Results
From 218 patients with EVT, DH was performed in 20 patients (9.2%). Baseline- (7 vs. 9; p =
0.009) and follow-up ncCT ASPECTS (1 vs. 7, p<0.001) as well as baseline CBV ASPECTS
(5 vs. 7, p<0.001) were significantly lower in patients with DH. ncCT (baseline: OR 0.71, p =
0.018; follow-up: OR 0.32, p = <0.001) and CBV ASPECTS (OR 0.63, p = 0.008) predicted
DH. Cut-off ncCT-ASPECTS on baseline was 7-, ncCT-ASPECTS on follow-up was 4- and
CBV ASPECTS on baseline was 5 points.
Conclusions
ASPECTS could be useful to early identify patients requiring DH after EVT for acute large
vessel occlusion.Open-Access-Publikationsfonds 2017peerReviewe