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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Claus Ziegler Simonsen, Aarhus University
- Second opponent: Head of Department Gordian Hubert, München Klinik Harlaching
- Third member and chair of the evaluation committee: Associate Professor Anne Cecilie Kjeldsen Larstorp, University of Oslo
Chair of the Defence
Professor Are Martin Holm, University of Oslo
Principal Supervisor
Researcher Else Charlotte Sandset, University of Oslo
Summary
Acute stroke is a time sensitive medical emergency. Treatment is more effective the earlier it is administered. Prehospital identification and triage of acute stroke patients is therefore vital for patient outcomes. Yet commonly used tools for prehospital stroke recognition, such as the Face Arm Speech Time test (FAST), miss up to 30% of all strokes. This is even higher among patients with minor strokes, which represent the majority of cases.
The standard prehospital examination of stroke in Norway is FAST. This thesis evaluated a new approach consisting of structured stroke training for paramedics, prehospital National Institutes of Health Stroke Scale (NIHSS) using a mobile application, and standardized communication with stroke physicians. The aim was to improve prehospital diagnostic accuracy.
Methods included a validation study confirming equivalence between app based and paper NIHSS, and a stepped wedge cluster randomized trial in the Oslo ambulance service involving patients with suspected acute stroke, with additional analyses of those with mild minor stroke, defined as NIHSS 0–2.
The intervention did not increase overall diagnostic accuracy, but patients assessed with NIHSS arrived at hospital with lower NIHSS scores, indicating improved detection of subtle strokes. Prehospital time increased, likely due to pandemic related factors, while in hospital time decreased through more efficient communication. Among suspected mild minor strokes, there was a significant overlap in symptom presentation between strokes and non-stroke patients. NIHSS showed high sensitivity (95%) but low specificity (16%) in this group.
Overall, prehospital NIHSS proved feasible, reliable, and valuable for identification of minor stroke.
Additional information
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