Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Chief Doctor Daniel Strbian, Helsinki University Hospital
- Second opponent: Associate Professor Jesper Blinkenberg, University of Bergen
- Third member and chair of the evaluation committee: Professor II Mona Kristiansen Beyer, University of Oslo
Chair of the Defence
Professor II Bjørn Naume, University of Oslo
Principal Supervisor
Christian Georg Lund-Berven, Oslo University Hospital
Summary
Acute stroke affects approximately 10.000 Norwegians annually. Early thrombolytic treatment of patients with ischemic stroke significantly improves prognosis, however treatment is time dependent and should in most patients be administered within 4.5 hours from onset of symptoms. To exclude cerebral haemorrhage, a rapid Computed Tomography (CT) scan of the brain must be performed. Stroke patients from rural areas in Norway may have a long transport time to hospital and arrive too late for treatment. The primary aim of this thesis was to examine the rationale, feasibility and potential utility of a rural CT station in prehospital stroke diagnosis and treatment.
Data from the Norwegian Stroke Registry demonstrate a significant inverse relationship between transport time in ambulance and frequency of reperfusion therapy. Alternative models such as Mobile Stroke Units have been tested to reduce the prehospital time delay. In the thesis Rural computed tomography and thrombolytic treatment for ischemic stroke Ibsen et al. explores effects of a decentralized CT and thrombolytic service in Hallingdal, Norway. During daytime, the service is operated by a local radiographer and a general practitioner. Out of office hours, the CT scanner is remotely controlled from Ringerike Hospital and trained paramedics are supervised over video link to perform diagnosis and treatment. In a clinical study, treated patients received thrombolysis 89 minutes earlier than patients from a similar rural district without a rural CT station.
In collaboration with the Norwegian Mapping Authority, we hypothetically deployed similar CT stations as in Hallingdal into rural areas in Norway. The deployment resulted in a significant reduction in transport times and an increased odds ratio for good outcome in case of ischemic stroke. Such deployment may be feasible due to utilization of telemedicine and paramedics already on-call, however cost-benefit analyses are up to now not performed.
Additional information
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