A Scoping Review of Pre-hospital Technology to Assist Ambulance Personnel with Patient Diagnosis or Stratification during the Emergency Assessment of Suspected Stroke

Hannah Lumley, Darren Flynn, Graham McClelland, Gary A. Ford, Phil White, Christopher Price

Research output: Contribution to journalArticle

Abstract

Background: Pre-hospital identification of key subgroups within the suspected stroke population could reduce delays to emergency treatment. We aimed to identify and describe technology with existing proof of concept for diagnosis or stratification of patients in the pre-hospital setting.

Methods: A systematic electronic search of published literature (from 01/01/2000 to 06/06/2019) was conducted in five bibliographic databases. Two reviewers independently assessed eligibility of studies or study protocols describing direct stratification methods (portable imaging/biomarkers) or facilitative technology (telemedicine) used by ambulance personnel during the assessment of suspected stroke. Eligible descriptions involved use of technology during the actual assessment of suspected stroke to provide information directly to ambulance personnel in the prehospital setting. Due to study, intervention and setting heterogeneity there was no attempt at meta-analysis.

Results: 2887 articles were screened for eligibility, 19 of which were retained. Blood biomarker studies (n=2) were protocols of prospective diagnostic accuracy studies, one examining purines and the other a panel of known and novel biomarkers for identifying stroke sub-types (versus mimic). No data were available on diagnostic accuracy or patient health outcomes. Portable imaging studies (n=2) reported that an infrared screening device for detecting haemorrhages yielded moderate sensitivity and poor specificity in a small study, whilst a dry-EEG study to detect large vessel occlusion in ischaemic stroke has not yet reported results. Fifteen evaluations of pre-hospital telemedicine were identified (12 observational and 3 controlled comparisons) which all involved transmission of stroke assessment data from the pre-hospital setting to the hospital. Diagnosis was generally comparable with hospital diagnosis and most telemedicine systems reduced time-to-treatment; however, it is unknown whether this time saving translated into more favourable clinical outcomes. Telemedicine systems were deemed acceptable by clinicians.

Conclusions: Pre-hospital technologies to stratify suspected stroke into clinically important subgroups may be feasible but insufficient evidence precludes recommendations on their routine use in the pre-hospital setting. Multi-centre diagnostic accuracy studies and clinical utility trials combining promising technologies are warranted.
Original languageEnglish
JournalBMC Emergency Medicine
DOIs
Publication statusAccepted/In press - 6 Apr 2020

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