Stroke reperfusion therapy is time critical. Improving pre-hospital diagnostic accuracy can aid in making efficient and appropriate diversion decisions and has the potential to improve onset-to-treatment time. Our aim was to investigate whether pre-hospital telestroke improves diagnostic accuracy when compared with paramedic assessments, and determine the ease of integrating this service into patient care.
We conducted a pragmatic, community-based, cluster randomised controlled trial of routine ambulance screening (FAST and glucose, seizure, and posterior circulation screen) plus specialist telestroke assessments inside the ambulance compared with routine ambulance screening plus modified Los Angeles Motor Scale (PASTA score). Primary outcome was the accuracy of predicting reperfusion candidates; secondary outcomes were accuracy, sensitivity, specificity, positive, and negative predictive values to identify, actual stroke patient, thrombolysis and thrombectomy candidates.
Of 76 patients (35 in the telestroke and 41 in the PASTA arms) recruited between August 2019 and September 2020, 38/76 (50%) had a final diagnosis of acute stroke and 12/76 (15.8%) received reperfusion therapy. Compared to neurologist assessment in the emergency department FAST+Telestroke was 100% (95% CI 90-100%) and FAST+PASTA 70.7% (54.5-83.9%) accurate in predicting ‘stroke for reperfusion’ (p=0.004). In predicting stroke for thrombolysis, telestroke was 97.1% (85.1-99.9%) and FAST+PASTA 61.0% (44.5-75.8%) accurate (p=0.002). In predicting eventual thrombectomy, telestroke was 88.6% (73.3-96.8%) and PASTA 56.1% (39.3-71.5%) accurate (p=0.004). Overall, the service model was acceptable to both neurologists and paramedics.
Pre-hospital telestroke assessment is feasible, highly accurate in diagnosing stroke for acute reperfusion therapies, and is superior to standard care plus the PASTA score.
ACTRN12619001678189