Prehospital CT for early diagnosis and treatment of suspected acute stroke or severe head injury - project description
In acute stroke and severe head injuries, timing of the treatment is crucial ("time is brain"). In stroke caused by blood clots (ischemic stroke or cerebral infarction), thrombolytic treatment (thrombolysis) should be given as soon as possible, at least within 4.5 hours after the onset of symptoms. In hemorrhagic stroke (bleeding), on the other hand, thrombolytic treatment is contra-indicated as it may cause life-threatening complications. On suspicion of acute stroke or a severe head injury, rapid admission to a hospital to undertake a computed tomography (CT) scan is recommended. In cases of acute stroke, thrombolytic treatment should be provided, as soon as hemorrhagic stroke has been ruled out. Adequate timing of all stages of the treatment chain is essential to minimize the damage caused by stroke. In head injuries, CT is used to identify (triage) those patients who should be admitted to a neurosurgical department. Prehospital CT, either in the form of stationary "CT stations" outside hospitals or mobile CT scanners adapted for use in ambulances, may in theory help determine which hospital the patient should be admitted to, as well as shorten the time from the first contact with the emergency dispatch center to provision of thrombolysis or other adequate treatment (either during transportation or in the hospital).
In this health technology assessment we will compare the effectiveness and safety of prehospital CT and subsequent treatment with current practice of diagnosis and treatment carried out after arrival in the hospital. In addition, we will assess organizational and health economic consequences related to the implementation of prehospital CT.
The complete project plan can be found in the column to the the left.