Rural CT Examination and Thrombolytic Treatment for Stroke

Study Overview
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Brief Summary
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To counteract long term sequelae from stroke, ultrarapid diagnosis and treatment, high quality multidiciplinary in-hospital care and optimal long term rehabilitation is required. In this study, the investigators are moving the essential first diagnosis and treatment out into the community close to where the patient live, thus shortening the all important time from debut of symptoms to thrombolytic treatment improving the prognosis of stroke patients.

Detailed Description
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Stroke is an acute, potentially mutilating disease. To counteract long term sequelae three factors are essential: Ultrarapid diagnosis and treatment, high quality multidiciplinary in-hospital care and optimal long term rehabilitation. Initial diagnosis and treatment has up to now been completed within the hospital domain. This study will change that: moving the essential first diagnosis and treatment out into the community close to where the patient lives thus shortening the all important time from debut of symptoms to thrombolytic treatment. We will operate a local computer tomography (CT) service in the hands of community based non-specialized health care personnel (MD and nurse) acting under direct telemetric guidance from on call hospital specialists. Thus, the investigators will show that by combining current technological advances in real time video communication with an acutely well functioning cooperation between the community and hospital health service personnel the prognosis of stroke patients is improved.

Official Title
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Rural CT Examination and Thrombolytic Treatment for Stroke: An Observational Study of Medical and Health Economic Effects

Conditions
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Stroke

Intervention / Treatment
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* Diagnostic Test: Rural CT scanning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients over 18 years being investigated by CT within 24 hours for acute symptoms of stroke. Fullfilling criteria for the diagnosis acute stroke as described by the Norwegian stroke registry. Giving informed consent. Exclusion Criteria: Symptoms not due to ischaemic or haemorrhagic stroke as adjudicated at discharge. Not able to cooperate to 3 months follow up. Not giving informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 1<br>Intervention group: Stroke patients investigated with rural CT scanning at HSS, Ål. Patients living in the municipalities of Hol, Ål, Gol, Hemsedal and Nes. | Diagnostic Test: Rural CT scanning<br>* Rural computer tomography for acute stroke<br>* Other names: Thrombolysis;|
| 2<br>Control-group: Stroke patients with similar transportation time to hospital, but no access to rural CT scanning. Patients living in the municipalities of Nore- and Uvdal, Vang, Øystre and Vestre Slidre, Lesja, Vågå, Lom, Dovre, Skjåk and Sel. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Thrombolytic treatment | The proportion of patients with ischaemic stroke receiving thrombolytic treatment in percent. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ictus to needle time | Time from onset of stroke symptoms (Ictus) to thrombolytic treatment (Needle). | 3 months | 
| Functional status | Modified Rankin Scale (mRS score 0-6). Good outcome 0-2 | 3 months | 
| Cognitive status | Montreal Cognitive Assessment (MoCA score 0-30). Good outcome 26-30 | 3 months | 
| Depression | Geriatric depression scale (GDS score 0-30). Good outcome 0-10 | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke, Thrombolysis, Rural CT